Bilateral Water‐Clear Cell Double Parathyroid Adenomas

Abstract

Objective: 1) Describe the pathologic findings of water-clear cell hyperplasia and adenomas. 2) Understand the clinical presentation of a patient with primary hyperparathyroidism caused by double water-clear cell parathyroid adenomas. Method: A 66-year-old white woman was referred to our clinic with hypercalcemia, osteoporosis, and hyperparathyroidism. Sestamibi scan was nonlocalizing and thyroid ultrasound revealed bilateral thyroid nodules. She underwent total thyroidectomy and bilateral superior parathyroidectomy. The inferior parathyroid glands appeared grossly normal and were left intact. Results: Intraoperative PTH dropped from 209 to 39.5 and postoperative calciums returned to the normal range. Pathology revealed bilateral superior parathyroid adenomas with the right superior gland weighing 2.14 g and the left weighing 1.27 g. Both glands were consistent with water-clear cell hyperplasia. The thyroid gland, of which FNA had returned preoperatively as atypia, revealed multinodular goiter. Conclusion: WCC hyperplasia is a rare cause of primary hyperparathyroidism. To our knowledge only one other case has been reported that revealed bilateral water-clear cell parathyroid adenomas. Unlike primary chief cell hyperplasia, WCC hyperplasia is not associated with MEN syndromes, and the incidence has decreased significantly over the past 25 years.