Parathyroidectomy guided by intraoperative parathyroid hormone monitoring in a case of parathyroid hyperplasia
| Autor: | Abdu Baset Labania Lena, Hassan Ibrahim Hassanein Eman, Kumar Bylappa Sunil, Nasir Hussain Maryam |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Thyroid nodules
Parathyroidectomy medicine.medical_specialty endocrine system diseases business.industry medicine.medical_treatment Urology Parathyroid hormone Hyperplasia medicine.disease Medicine Endocrine system business hormones hormone substitutes and hormone antagonists Primary hyperparathyroidism Hypophosphatemia Parathyroid adenoma |
| Zdroj: | International Journal of Case Reports and Images. 11:1 |
| ISSN: | 0976-3198 |
| DOI: | 10.5348/101139z01mh2020cr |
| Popis: | Introduction: Primary hyperparathyroidism (PHPT) is a common endocrine disorder of the parathyroid glands, characterized by excessive production of parathyroid hormone by one or more of the parathyroid glands, causing hypercalcemia. The cause is usually an abnormal group of cells forming a benign parathyroid adenoma, hyperplasia, or, rarely, a carcinoma. Primary hyperparathyroidism is typically diagnosed by routine serum chemistry analysis showing hypercalcemia, hypophosphatemia, and elevated parathyroid hormone (PTH) level. Case Report: A case report of a 54-year-old female who presented with pain, swelling, and itching in the front of the neck for few months. Laboratory investigations revealed sustained hypercalcemia and gradually elevating PTH level. Computed tomography (CT) scan showed multiple hypo-enhancing thyroid nodules in both lobes. Ultrasonography (USG) showed an enlarged thyroid gland with multiple variable-sized cystic to spongiform nodules suggesting multinodular colloid goiter. Total thyroidectomy with right superior parathyroidectomy was done. Intraoperative PTH level monitoring showed markedly decreased level. Microscopically, fat tissue was present throughout the sections, no compressed tissue at the periphery, few chief and oxyphil (oncocytic) cells were seen. Conclusion: These findings were most consistent with parathyroid hyperplasia. However, PTH level decreased immediately after surgery for >50% (Miami or “>50% intraoperative PTH drop” criterion). It can be either due to parathyroid adenoma or single gland hyperplasia. Thus, it could be challenging to distinguish between parathyroid adenoma and hyperplasia. Correct diagnosis is achieved only after correlating the pathologic findings with the clinical setting and biochemical results and it is advised for long-term follow-up with PTH level in cases of hyperplasia. |
| Databáze: | OpenAIRE |
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