Endocrine Abstracts

Introduction: Parathyroid adenomas are rarely large in size. Here, we present a giant cystic parathyroid adenoma presented with pancytopenia.

Case report: Twenty two years old female presented with fatigue, bone pain, polyuria, a lump in the neck and pancytopenia. She had a pulsatile mass on the right side of the neck which compressed her trachea. She was evaluated by Hematology since her Hb was 4.7 g/dl, WBC was 2200 u/l platelet count was: 69 000 u/l. Bone marrow biopsy revealed myelofibrosis. During her evaluation, she was found to have a brown tumor on her right mandible with Ca: 12 mg/dl (8.6–10), P: 2.2 mg/dl (2.3–4.7), ALP: 135 U/l (35–104), PTH: 327 pg/ml (15–65), 25(OH)D: 6.8 ng/ml (30–80) and 24-h urine Ca: 320 mg/day. She was referred to Endocrinology. Her bone survey revealed diffuse osteoporosis, and brown tumor of right mandible. T scores obtained by DXA were: Lumber vertebra: −4.3 Femur neck: −3.4 Distal radius: −5.6. Glomerular filtration rate was calculated as 72 ml/min. She had no history of renal stones and renal ultrasonography reveled no stones. Her parathyroid ultrasonography and scintigraphy confirmed the presence of giant parathyroid adenoma 8×8×14 cm in dimensions, extending into the mediastinum. She received iron and vitamin D for three months followed by adenoma excision. Her surgery was unique among other surgeries performed to patients with giant adneomas since it was only performed by a servical incision without the need for thoracotomy. After the excision, intraoperative PTH level was measured as 87 pg/ml. Three months after the operation her Ca, P, ALP and PTH levels and her blood count were normal.

Conclusions: Animal and human studies suggest a myelofibrotic role for high PTH levels. However, very few patients present with pancytopenia due to myelofibrosis. This patient with chronic primary hyperparathyroidism presented with myelofibrosis that resolved after paratahyroidectomy.