Ho Joon, Kim Donggyu, Lee Ji-Eun, Choi Soonmin, Choi Hyeryeon, Choi Sunhyung, Kim Jinkyung, Kang Sang-Wook, Lee Jandee, Jeong Jong Ju, Nam Kee-Hyun, Chung Woong Youn
Department of Surgery, Severance Hospital, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea.
Gland Surg. 2021 Jun;10(6):2047-2053. doi: 10.21037/gs-21-6.
Hyperparathyroidism is not a rare disease; if a parathyroid adenoma is confirmed, the treatment of choice is the surgical resection. Diagnostic use of fine-needle aspiration biopsy (FNAB) for histological confirmation in patients with hyperparathyroidism is controversial. And spontaneous remission of hyperparathyroidism caused by bleeding or infarction of the adenoma rarely occurs. Here we have reported two cases of hyperparathyroidism in which spontaneous remission occurred due to the use of FNAB for diagnosis. The remission was confirmed after surgical removal and pathological review of the adenoma. The first patient diagnosed with primary hyperparathyroidism (PHPT) had neck pain and severe swelling 4 days after FNAB, and spontaneous remission due to intracapsular hemorrhage was confirmed after surgery. In the second patient receiving hemodialysis treatment for end-stage renal disease, hyperparathyroidism spontaneously resolved after FNAB and the parathyroid hormone (PTH) levels normalized after surgery. The first patient maintained a normal level of PTH for 6 years, and the second patient received kidney transplantation 6 years after surgery, and the normal level of PTH was confirmed for 13 years. Caution is needed while performing FNAB for diagnosis of hyperparathyroidism and during decision making regarding whether to observe the patient or perform surgery after spontaneous remission due to bleeding or infarction.
甲状旁腺功能亢进并非罕见疾病；若确诊为甲状旁腺腺瘤，首选治疗方法是手术切除。对于甲状旁腺功能亢进患者，使用细针穿刺活检（FNAB）进行组织学确诊的诊断用途存在争议。并且由腺瘤出血或梗死引起的甲状旁腺功能亢进自发缓解很少发生。在此我们报告了两例甲状旁腺功能亢进病例，其中由于使用FNAB进行诊断而发生了自发缓解。在手术切除腺瘤并进行病理检查后证实了缓解情况。首例被诊断为原发性甲状旁腺功能亢进（PHPT）的患者在FNAB后4天出现颈部疼痛和严重肿胀，术后证实因囊内出血而自发缓解。在第二例接受终末期肾病血液透析治疗的患者中，FNAB后甲状旁腺功能亢进自发缓解，术后甲状旁腺激素（PTH）水平恢复正常。首例患者PTH水平维持正常6年，第二例患者术后6年接受肾移植，PTH正常水平得到证实达13年。在对甲状旁腺功能亢进进行FNAB诊断时以及在因出血或梗死导致自发缓解后决定是观察患者还是进行手术时都需要谨慎。
