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Case Reports
. 2021 May 25;14(5):e239119.
doi: 10.1136/bcr-2020-239119.

Incidentally discovered severe hypercalcaemia from a functioning parathyroid cyst: the limitations of intraoperative parathyroid hormone (IOPTH) monitoring

Juan Carlos Nogues  1   2 , Robert Cox  3 , Collin Mulcahy  3 , Daniel Benito  3 , Joseph Goodman  3
Affiliations
Case Reports

Incidentally discovered severe hypercalcaemia from a functioning parathyroid cyst: the limitations of intraoperative parathyroid hormone (IOPTH) monitoring

Juan Carlos Nogues et al. BMJ Case Rep. .

Abstract

Parathyroid cysts (PCs) are rare pathologies and are typically non-functional (do not secrete parathyroid hormone (PTH)). The aetiology of PCs is highly debated, and management is complex. We present a unique case of a parathyroid adenoma contained within a functional PC and highlight the limitations of intraoperative PTH monitoring during the surgical resection of functional PCs.

Keywords: calcium and bone; ear; endocrine system; nose and throat; nose and throat/otolaryngology; thyroid disease.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
(A) Coronal image of four-dimensional CT (4D-CT) scan. Green arrow indicates adenoma within parathyroid cyst. (B) Dual-phase Tc99 sestamibi scan with delayed radiotracer washout at the level of the adenoma. (C) Axial slice of 4D-CT scan demonstrating the adenoma within parathyroid cyst (green arrow).
Figure 2
Figure 2
Intraoperative PTH concentration from peripheral venous sampling. Time 0 min represents measurement just prior to the excision of PC. PC, parathyroid cyst; PTH, parathyroid hormone.
Figure 3
Figure 3
The long-term trends of parathyroid hormone (PTH) concentration drawn from peripheral blood samples. Postoperative days 1–3 PTH levels represent the average concentration of all measurements taken during each day, as PTH was measured multiple times within a 24-hour period.
See this image and copyright information in PMC

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