Crippling bone deformities and a palpable neck lump; rare presentation of a giant parathyroid adenoma

Zain Ul Abideen,Abdullah Abbasi,Adnan Arif,Chaudhary Muhammad Junaid Nazar,Fizza Aroj Aroj

doi:10.15171/jpd.2017.03

Abstract

The most common cause of primary hyperparathyroidism is a solitary parathyroid adenoma. The different manifestations of the disease are due to excess parathyroid hormone (PTH) secretion. Giant parathyroid weigh more than 2 g and are rarely evident in clinical examination. We present a young man who presented with severe bone deformities and a palpable neck lump. After surgery, a giant parathyroid adenoma was removed that weighed 33 g. Adenomas weighing more then 30 g are rare and presentation as a neck lump and severe bone disease has seldom been described. In patients presenting with a palpable neck lump, severe bone disease and renal calculi giant parathyroid adenomas should be considered as a possible culprit.

Highlights

The incidence of primary hyperparathyroidism is 25 cases per 100 000 per year [1]
Implication for health policy/practice/research/ medical education In patients presenting with a palpable neck lump, severe bone disease and renal calculi giant parathyroid adenomas should be considered as a possible culprit
magnetic resonance imaging (MRI) of the neck revealed a 3.5×3 cm heterogeneous soft tissue intensity nodule in the posterior inferior aspect of the right thyroid lobe with anterior displacement of the thyroid suggestive of a parathyroid adenoma (Figure 3)

Summary

Introduction

The incidence of primary hyperparathyroidism is 25 cases per 100 000 per year [1]. The most common cause in 85% of patients is a solitary parathyroid adenoma. Giant parathyroid adenomas do not produce severe symptomatic disease [7] These tumours are not appreciable on clinical examination of the neck. We were surprised to come across a giant parathyroid adenoma during surgery that was the culprit behind these features and was producing the swelling in the neck. Implication for health policy/practice/research/ medical education In patients presenting with a palpable neck lump, severe bone disease and renal calculi giant parathyroid adenomas should be considered as a possible culprit. MRI of the neck revealed a 3.5×3 cm heterogeneous soft tissue intensity nodule in the posterior inferior aspect of the right thyroid lobe with anterior displacement of the thyroid suggestive of a parathyroid adenoma (Figure 3). Patient underwent a neck exploration for the adenoma, which was isolated from the right retro thyroid area (Figure 4) It was sent for histopathology which revealed typical parathyroid tissue. He comes for routine follow up and is enjoying a healthy life

Discussion

Findings

Conclusion