Manouras Andreas, Toutouzas Konstantinos G, Markogiannakis Haridimos, Lagoudianakis Emmanuel, Papadima Artemis, Antonakis Pantelis T, Kafiri Georgia, Bramis Ioannis
Department of Endocrine Surgery, First Department of Propaedeutic Surgery, Hippokration Hospital, University of Athens, Athens Medical School, Athens, Greece.
Head Neck. 2008 Jan;30(1):127-31. doi: 10.1002/hed.20661.
We report a case of intracystic hemorrhage in a mediastinal cystic parathyroid adenoma causing parathyrotoxic crisis.
A 30-year-old man presented with a large neck mass, dyspnea, and abdominal pain. The patient's serum calcium and parathormone levels were elevated. Radiography showed a right tracheal deviation, ultrasonography identified a thyroid nodular goiter extending to the mediastinum with a large (4.0 cm x 5.6 cm) cystic mass adjacent to the lower left thyroid pole. After IV fluid, pamidronate, and furosemide were administered, the patient underwent total thyroidectomy, and excision of the cyst and a small mass (2 cm x 2 cm) adjacent to the upper right thyroid lobe. Histopathologic examination revealed a double parathyroid adenoma and identified the mediastinal lesion as a cystic adenoma with intracystic hemorrhage.
Intracystic hemorrhage in a functional mediastinal cystic parathyroid adenoma is an extremely rare cause of parathyrotoxic crisis. Aggressive medical treatment should be immediately instituted, and surgery should be performed as soon as hypercalcemia is controlled.
我们报告一例纵隔囊性甲状旁腺腺瘤内囊出血导致甲状旁腺毒性危象的病例。
一名30岁男性出现颈部巨大肿块、呼吸困难和腹痛。患者血清钙和甲状旁腺激素水平升高。X线检查显示气管右偏，超声检查发现甲状腺结节性甲状腺肿延伸至纵隔，左下甲状腺极旁有一个大的（4.0 cm×5.6 cm）囊性肿块。给予静脉补液、帕米膦酸盐和呋塞米后，患者接受了全甲状腺切除术，并切除了囊肿及右上甲状腺叶旁的一个小肿块（2 cm×2 cm）。组织病理学检查发现双发性甲状旁腺腺瘤，并确定纵隔病变为伴有囊内出血的囊性腺瘤。
功能性纵隔囊性甲状旁腺腺瘤内囊出血是甲状旁腺毒性危象极其罕见的原因。应立即采取积极的药物治疗，一旦高钙血症得到控制，应尽快进行手术。
