Abstract
BackgroundPrimary hyperparathyroidism is a rare condition of disease which can seldomly present as giant retrotrhyroideal cysts, complicating the localization of the adenoma to resect.Case presentationA 56-year old female presented with hypercalcaemia of 3.38 mmol/L (2.2–2.65 mmol/L) and a history of breast cancer. A fast growing cystic parathyroidal adenoma was diagnosed by a multimodal approach including comprehensive diagnostic imaging (ultrasonography, scintigraphies, dynamic MRI) and cytopathological investigations after ultrasonography-guided puncture. The patient was cured by surgical extraction of the whole adenoma. In retrospect, the rapid growth was most likely induced by cinacalcet (initially 30 mg/d, later 60 mg/d) therapy which the patient received for few months only. Primary hyperparathyroidism was ascertained because surgical removal of the solitary adenoma cured the patient. Furthermore, there was no relevant renal insufficiency or history of prolonged calcium-level deregulation.ConclusionsThis phenomenon of cystic degeneration of parathyroidal adenoma under therapy with cinacalcet has previously been described in secondary hyperparathyroidism, but not in primary hyperparathyroidism and should be considered in diagnostic approach.
Highlights
Primary hyperparathyroidism is a rare condition of disease which can seldomly present as giant retrotrhyroideal cysts, complicating the localization of the adenoma to resect.Case presentation: A 56-year old female presented with hypercalcaemia of 3.38 mmol/L (2.2–2.65 mmol/L) and a history of breast cancer
This phenomenon of cystic degeneration of parathyroidal adenoma under therapy with cinacalcet has previously been described in secondary hyperparathyroidism, but not in primary hyperparathyroidism and should be considered in diagnostic approach
Primary hyperparathyroidism is a rare condition of disease resulting from either hyperplastic or adenomatous parathyroid tissue
Summary
Primary hyperparathyroidism is a rare condition of disease which can seldomly present as giant retrotrhyroideal cysts, complicating the localization of the adenoma to resect.Case presentation: A 56-year old female presented with hypercalcaemia of 3.38 mmol/L (2.2–2.65 mmol/L) and a history of breast cancer. Conclusions: This phenomenon of cystic degeneration of parathyroidal adenoma under therapy with cinacalcet has previously been described in secondary hyperparathyroidism, but not in primary hyperparathyroidism and should be considered in diagnostic approach. Giant volumes are reported and iPTH measurement in cystic fluid was found to be a useful method to confirm diagnosis [1,2,3]. * Correspondence: christoph.werner@med.uni-jena.de 1Clinic of Internal Medicine III, Jena University Hospital, Am Klinikum 1, 07747
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