Endocrine Abstracts

JOINT2016

Introduction: Primary hyperparathyroidism is a common endocrine pathology, explained in the majority of cases by the presence of a parathyroid adenoma, located in the cervical region. Intrathyroid localization of the parathyroid adenoma is rare and can be a cause of failure of surgical treatment. We report a case of intrathyroid parathyroid adenoma.

Observation: This is a 72-year-old patient, diabetic hypertensive, admitted for management of hypercalcemia discovered during the exploration of diffuse joint and bone pain. The etiological and impact assessment showed corrected calcemia at 2.8 mmol/l, hypophosphatemia, hypovitaminosis D at 14.2, and parathyroid hormone at 494 pg/ml. The cervical ultrasound showed a thyroid nodule of 33x17 mm classified EUTIRADS III. SPECT-CT objectified an intralobar nodule intensely fixing the MIBI. An in situ PTH dosage was performed returning 9698 pg/ml. The patient had oral hydration, and a right loboisthmectomy. The intraoperative frozen section and final histological examination confirmed the intrathyroidal localization of a parathyroid adenoma. The evolution was favorable with normalization of calcemia and PTH in the postoperative period.

Conclusion: Parathyroid ectopia is one of the causes of failure of surgical treatment of hyperparathyroidism. Intrathyroid localization must not be overlooked in order to successfully perform surgery for hyperparathyroidism. The current therapeutic strategy aims at preoperative identification of pathological parathyroid glands that combines data from cervical ultrasound, MIBI-Tc99m scintigraphy and exploratory cervicotomy.