The Clinical Features of Cystic Parathyroid Adenoma in Chinese Population: A Single-Center Experience.

Ya Hu,Yuxin Jiang,Zhe Su,Ming Cui,Quan Liao,Yu Xia,Yupei Zhao,Xiang Zhang

doi:10.1155/2018/3745239

Abstract

Objective Cystic parathyroid adenoma is a rare cause of primary hyperparathyroidism, but its preoperative diagnosis and management remain inconclusive. Method We retrospectively identified patients with cystic parathyroid adenomas who underwent surgery at Peking Union Medical College Hospital. Results Patients with cystic parathyroid adenomas had higher serum intact parathyroid hormone and calcium levels, larger maximum tumor diameter, and lower serum inorganic phosphorus level than did those with solid adenomas. Patients with cystic adenomas were predominantly male, and hypercalcemic crisis and atypical adenomas were common. The accuracy of preoperative localization methodologies was lower in patients with cystic adenomas than in patients with solid adenomas. US-guided fine-needle aspiration was performed in 11 patients. In all patients, the iPTH level in cystic fluid was much higher than that in serum. No sign of recurrence was observed after a median follow-up of 39 months. Conclusions Cystic parathyroid adenomas may not be as rare as previously reported. FNA may be a safe and feasible localization methodology for patients with inconclusive preoperative localization methodologies. Close follow-up is necessary for patients with cystic parathyroid adenomas, which account for a substantial proportion of atypical adenoma cases.

Highlights

Primary hyperparathyroidism (PHPT) is the most common disease in parathyroid glands and is accompanied by excessive secretion of parathyroid hormone (PTH) [1]
The preoperative serum levels of total calcium and intact PTH (iPTH) were significantly higher in patients with cystic adenomas than in patients with solid adenomas
Cystic parathyroid adenomas are traditionally believed to represent a small percentage of PHPT cases

Summary

Introduction

Primary hyperparathyroidism (PHPT) is the most common disease in parathyroid glands and is accompanied by excessive secretion of parathyroid hormone (PTH) [1]. Single parathyroid adenomas account for approximately 80–90% of PHPT cases. Cystic parathyroid adenomas are reported to be very rare and account for 1-2% of PHPT cases [2]. It is reported that cystic parathyroid adenomas account for approximately 9% of parathyroid cysts and are more common in males [6]. The fluid in most functional parathyroid cysts is not clear but bloody or dark brown in color [4, 9]. Several explanations have been suggested for the pathogenesis of cystic parathyroid adenomas, including the retention of glandular secretion or the persistence of embryological remnants of the 3rd and 4th pharyngeal pouches [10]

Methods

Results

Conclusion