Division of Endocrinology, Diabetes and Metabolism, Departments of Medicine (M.R.R., S.J.M.) and Radiology (J.E.L., S.J.M.), University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104
Address all correspondence and requests for reprints to: Susan J. Mandel, M.D., M.P.H., Hospital of the University of Pennsylvania, 1 Maloney, Endocrine Clinic, 3400 Spruce Street, Philadelphia, Pennsylvania 19104. E-mail: smandel{at}mail.med.upenn.edu.
A 54-yr-old man had nephrolithiasis attributed to primary hyperparathyroidism based on elevated concentrations of serum calcium [11.4 mg/dl (2.8 mmol/liter); normal, 8.510.6 mg/dl (2.12.6 mmol/liter)], serum intact PTH [151 pg/ml (16 pmol/liter); normal, 1272 pg/ml (1.37.6 pmol/liter)], and 24-h urine calcium [271 mg (6.8 mmol); normal, <200 mg (5.0 mmol)]. Figure 1 depicts the preoperative imaging. A planar parathyroid scan performed 2 h after the administration of technetium sestamibi demonstrated persistent uptake at the right lower pole of the thyroid (Fig. 1A
, arrow), a result consistent with the presence of a parathyroid adenoma. An ultrasound evaluation demonstrated a 1.7-cm predominantly cystic nodule in the right lower pole of the thyroid (Fig. 1B
, circle), and ultrasound-guided fine-needle aspiration yielded epithelial cells possibly representing parathyroid tissue. A subsequent needle pass attempting to sample the cyst fluid yielded bloody material of insufficient quantity to analyze for intact PTH.
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Parathyroid cysts are uncommon causes of neck or mediastinal masses, and only rarely result in primary hyperparathyroidism (1, 2, 3). They have been mistaken for cystic thyroid nodules, branchial cleft cysts, or thyroglossal duct cysts (1). The diagnosis of a parathyroid cyst can be made either by finding a markedly elevated level of intact PTH in the cyst fluid (1, 2) or by the pathologic identification of parathyroid epithelium within the cyst wall (1, 3). A parathyroid cyst may be the cause of primary hyperparathyroidism when preoperative imaging demonstrates an intra- or perithyroidal cystic mass lesion.
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Footnotes |
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Received October 22, 2003.
Accepted November 14, 2003.
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