The most frequent pathology of primary hyperparathyroidism presented with the findings of hypercalcemia is parathyroid adenoma. Some patients having the signs of primary hyperparathyroidism may have intrathyroidal parathyroid adenoma and it may be overlooked. We present a case of intrathyroidal parathyroid adenoma presented with bone pain.
47-year-old female patient referred to our clinics with bone pain and she had no pruritus, dry mouth, dyspepsia, abdominal pain, nausea, vomiting, polyuria or polydipsia. She did not have any history of hypertension, nephrolithiasis, renal failure or bone fracture; and she was taking risedronate for one week for osteoporosis. On physical examination, vital signs and systemic findings were normal. Blood count revealed mild anemia (hemoglobin:10 gr/dl, MCV:80 fL); and in biochemical analysis, creatinine was 0.65 mg/dl, Ca:12 mg/dl, P:2.2 mg/dl, Mg:2.07 mg/dl, albumin:3.1 gr/dl, ALP:738 U/l. Hormonal parameters showed biochemical primary hyperparathyroidism (PTH:1938 pg/ml, 25(OH)D3:<3 ng/ml). BMD showed severe osteoporosis in lumbar vertebra (T score −4.0). There were osteopenia in bone X-rays and Brown tumor in fifth metacarpal bone of right hand. No nephrolithiasis or nephrocalcinosis were found in abdominal sonography. Neck sonography revealed a large (37×24 mm), vascular, heterogenous nodule having both cystic and solid areas in right lobe of the thyroid gland. 99mTc-sestamibi scintigraphy showed MIBI uptake in the nodule, making us to define the nodule as intrathyroidal parathyroid adenoma. Then, the patient underwent to surgery, and right hemithyroidectomy was done; and postoperative pathological examination confirmed the parathyroid adenoma. Postoperative calcium and PTH levels were 7.3 mg/dl and 24.3 pg/ml.
When clinical and biochemical findings point to primary hyperparathyroidism, we should keep in mind that intrathyroidal nodules may be parathyroid adenoma.
20 - 23 May 2017
European Society of Endocrinology