Departamento de Investigación, Universidad Autonóma de Chihuahua, Facultad de Medicina y Ciencias Biomédicas, Nuevo Campus Universitario, 31125, Chihuahua, Mexico.
Departamento de Cirugía, Hospital Central del Estado, Antonio Rosales 33000, Obrera, 31350, Chihuahua, Mexico.
J Med Case Rep. 2023 Sep 1;17(1):373. doi: 10.1186/s13256-023-04102-w.
There is some evidence supporting the idea that double parathyroid adenomas represent a different entity from multiglandular hyperplasia; however, the distinction among them is not straightforward.
We described a case of primary hyperparathyroidism (PHPT) with pronounced clinical manifestations, caused by a bilateral giant parathyroid adenoma. A 34-year-old Hispanic/Latino male was diagnosed with PHPT caused by two giant parathyroid adenomas. The preoperative tests were neck ultrasound and computed tomography scan (CT-scan), showing two masses in the territory of parathyroid glands, bilaterally distributed (right was 31 × 18 × 19 mm and the left was 38 × 15 × 14 mm); sestamibi scan was not available. Parathyroid hormone (PTH) was highly elevated. Multiple complications of PHPT were present, such as bone lytic lesions, renal and pancreatic calcifications, and cardiovascular disease, the latter of which is an overlooked complication of PHPT. Multiple endocrine neoplasia 1 and 2 (MEN 1/2) were ruled out by the absence of clinical, biochemical, and radiological findings in other endocrine glands. The patient underwent subtotal parathyroidectomy with an intraoperative histopathological study; both intraoperative and definitive histopathology results were consistent with parathyroid adenomas; afterward, adequate suppression of PTH was assured, and later on, the patient presented hungry bone syndrome (HBS).
The diagnosis of double parathyroid adenomas is difficult. Regarding the similarities between multiglandular hyperplasia and parathyroid adenomas, this case report contributes to the further distinction between these two clinical entities. This case report also represents, in particular, the challenge of difficult diagnosis in places with limited resources, such as developing countries.
有一些证据支持这样一种观点，即双侧甲状旁腺腺瘤代表一种与多腺体增生不同的实体；然而，它们之间的区别并不明显。
我们描述了一例表现为明显临床表现的原发性甲状旁腺功能亢进症（PHPT），由双侧巨大甲状旁腺腺瘤引起。一名 34 岁的西班牙裔/拉丁裔男性被诊断为双侧巨大甲状旁腺腺瘤引起的 PHPT。术前检查为颈部超声和计算机断层扫描（CT 扫描），显示甲状旁腺区域有两个肿块，双侧分布（右侧为 31×18×19mm，左侧为 38×15×14mm）；无法进行 sestamibi 扫描。甲状旁腺激素（PTH）显著升高。PHPT 存在多种并发症，如骨溶骨性病变、肾和胰腺钙化以及心血管疾病，后者是 PHPT 被忽视的并发症。通过排除其他内分泌腺的临床、生化和影像学表现，排除了多发性内分泌肿瘤 1 型和 2 型（MEN 1/2）。患者接受了甲状旁腺次全切除术，并进行了术中组织病理学研究；术中及最终组织病理学结果均与甲状旁腺腺瘤一致；随后，确保 PTH 得到充分抑制，随后患者出现饥饿骨综合征（HBS）。
双侧甲状旁腺腺瘤的诊断较为困难。鉴于多腺体增生与甲状旁腺腺瘤之间的相似性，本病例报告有助于进一步区分这两种临床实体。本病例报告还特别代表了在资源有限的国家等发展中国家进行困难诊断的挑战。
