Endocrine Abstracts

Introduction: Parathyroid adenomas appear typically as homogeneous, hypoechoic lesions compared to the thyroid on the ultrasonography examination. They can be detected easily when they are more than 1 cm. However, cystic parathyroid adenomas are rare. When present, they appear as decreased echogenic areas in the gland. Extrathyroidal feeding from an artery at one pole of the gland is characteristic which is seen on Doppler imaging. We aimed to present a case series including seven cases in which glands looked partially cystic and heterogenic from the 88 primary hyperparathyroidism patients presented to our clinic.

Materials and methods: Eighty-eight patients who were diagnosed with primary hyperparathyroidism between January 2010 and September 2012 were reviewed retrospectively. All the cases were diagnosed with primary hyperparathyroidism in the endocrinology outpatient clinic for room surgery was planned. All the cases were confirmed to have primary hyperparathyroidism histologically. Sonographic images and reports were obtained from the archives and they were reanalyzed. All of the ultrasonography images were taken by high resolution superficial tissue probes with 13 MHz (Hitachi EUB 7000, Tokyo, Japan). The inside of the lesions looked frequently highly hypoechoic and homogeneous but less hypoechoic compared to solid and strap muscles. Six cases which had atypical appearance with a lesion that was heterogeneous and included cystic areas were separated and investigated further. Demographic features of those patients were as follows: mean age was 51±14.5 and all of them were female. All of these cases were sent to ultrasonography because of suspicion of a parathyroid lesion based on clinical and laboratory evidence including elevated parathyroid hormone and or high serum calcium values. On the ultrasound, five of the lesions were located on the left and one was located on the right and they were frequently observed postero-inferior to the thyroid lobe on the left. Sonographicly, the longitudinal dimention of the adenomas were more than 2 cm (by dimention: 2.8±0.7). Mean PTH: 185±38, Ca=10.9±0.8. Both mean PTH and calcium were elevated. In histopathologic examination all cases were diagnosed with parathyroid adenoma.

Conclusion: Cystic parathyroid adenomas are presented in the literature as case reports. Cystic parathyroid adenomas were more frequently detected in our clinic then reported in the literature (7%), and clinically our cases had higher PTH and calcium values and a larger dimentions compared to the cases reported in the literature. Based on these features our patients may need to be evaluated as a separate group.