ECE2021 Presented Eposters Presented ePosters 6: Calcium and Bone (8 abstracts)
A rare cause of persistent hyperparathyroidism
Iconaru Laura 1 , Spinato Linda 2 , Duttmann Ruth 2 , Hambye Anne-Sophie 2 , Devriendt Arnaud 2 , Herchuelz Maxime 2 , Mathey Celine 3 , Karmali Rafik 2 & Bergmann Pierre 2
1CHU Brugmann, Endocrinology, Bruxelles, Belgium; 2CHU Brugmann, Bruxelles, Belgium; 3Hospital Erasme, Bruxelles, Belgium
Ectopic parathyroid tissue remains a significant hurdle in the surgical management of hyperparathyroidism. In diagnostically challenging cases of persistent hyperparathyroidism, unusual ectopic locations of parathyroid adenomas must be considered in order to avoid numerous re-operative explorations and the associated risks to the patient. We present a 30-year-old female was referred to the endocrinology department for symptomatic hypercalcemia. Routine laboratory investigations showed a severe hypercalcemia (corrected serum calcium: 3.4 mmol/l), with an intact parathyroid hormone serum concentration of 269 ng/l. The serum phosphate was low (0.63 mmol/l) and urinary calcium was 5.1 mmol/24 hours (N). A 99mTc sestamibi scintigraphy showed a focus of radioactivity compatible with a hyperfunctioning lower right parathyroid. Thus, the lower right parathyroid gland was excised, with intra-operative testing for parathyroid hormone. Because the PTH value remained high the surgeon decided to remove 2.5 of the 3 remaining parathyroid glands, but the PTH value did not decrease. Pathology revealed 2 hyperplastic, 1 normal parathyroid gland and thymus gland instead of left lower parathyroid. A technetium (99mTc) sestamibi scan was performed, but the result was not conclusive. The patient underwent a Choline PET/CT, which showed a left retro-pharyngeal active nodule corresponding to a possible ectopic parathyroid tissue. The patient had a successful transoral removal of the lesion with normalization of serum calcium and iPTH after surgery. Pathology confirmed the presence of a parathyroid adenoma (3.2 × 1.7 × 1.2 cm, weighting 3.9 g). The genetic tests showed no mutations in the CDKN1B, MEN and RET genes. In conclusion, we reported a case with persistent hyperparathyroidism after cervical surgery, due to an ectopic retro-pharyngeal parathyroid adenoma for which different imaging techniques and particularly 18F-fluorocholine PET/CT were essential in guiding the surgical approach and enabling the surgeon to successfully locate and remove the ectopic parathyroid.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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