Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2012 Jul 28:12:14.
doi: 10.1186/1472-6823-12-14.

A case report: Giant cystic parathyroid adenoma presenting with parathyroid crisis after Vitamin D replacement

Ali Asghar  1 , Mubasher Ikram, Najmul Islam
Affiliations

A case report: Giant cystic parathyroid adenoma presenting with parathyroid crisis after Vitamin D replacement

Ali Asghar et al. BMC Endocr Disord. .

Abstract

Background: Parathyroid adenoma with cystic degeneration is a rare cause of primary hyperparathyroidism. The clinical and biochemical presentation may mimic parathyroid carcinoma.

Case presentation: We report the case of a 55 year old lady, who had longstanding history of depression and acid peptic disease. Serum calcium eight months prior to presentation was slightly high, but she was never worked up. She was found to be Vitamin D deficient while being investigated for generalized body aches. A month after she was replaced with Vitamin D, she presented to us with parathyroid crisis. Her corrected serum calcium was 23.0 mg/dL. She had severe gastrointestinal symptoms and acute kidney injury. She had unexplained consistent hypokalemia until surgery. Neck ultrasound and CT scan revealed giant parathyroid cyst extending into the mediastinum. After initial medical management for parathyroid crisis, parathyroid cystic adenoma was surgically excised. Her serum calcium, intact parathyroid hormone, creatinine and potassium levels normalized after surgery.

Conclusion: This case of parathyroid crisis, with very high serum calcium and parathyroid hormone levels, is a rare presentation of parathyroid adenoma with cystic degeneration. This case also highlights that Vitamin D replacement may unmask subclinical hyperparathyroidism. Consistent hypokalemia until surgery merits research into its association with hypercalcemia.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Radionuclide parathyroid scintigraphy showing cystic lesion over left side of neck.
Figure 2
Figure 2
CT scan of head and neck showing parathyroid cystic mass extending into mediastinum.
Figure 3
Figure 3
a, b: Parathyroid adenoma lying adjacent to normal thyroid tissue. c, d: Parathyroid adenoma with predominant cystic degeneration.
See this image and copyright information in PMC

References

    1. Wermers RA, Khosla S, Atkinson EJ, Achenbach SJ, Oberg AL, Grant CS. Incidence of primary hyperparathyroidism in Rochester, Minnesota, 1993–2001: an update on the changing epidemiology of the disease. J Bone Miner Res. 2006;21(1):171–177. - PubMed
    1. Fraker DL, Harsono H, Lewis R. Minimally invasive parathyroidectomy: Benefits and requirements of localization, diagnosis, and intraoperative PTH monitoring. Long-term results. World J Surg. 2009;33(11):2256–2265. doi: 10.1007/s00268-009-0166-4. - DOI - PubMed
    1. McKay GD, Ng TH, Morgan GJ, Chen RC. Giant functioning parathyroid cyst presenting as a retrosternal goitre. ANZ J Surg. 2007;77(4):297–304. doi: 10.1111/j.1445-2197.2007.04037.x. - DOI - PubMed
    1. Fortson JK, Patel VG, Henderson VJ. Parathyroid cysts: a case report and review of the literature. Laryngoscope. 2001;111:1726. doi: 10.1097/00005537-200110000-00010. - DOI - PubMed
    1. Umemori Y, Makihara S, Kotani K, Washio K. Mediastinal parathyroid cyst with tracheal constriction. Jpn J Thorac Cardiovasc Surg. 2002;50(2):85–87. doi: 10.1007/BF02919671. - DOI - PubMed

LinkOut - more resources