Case report of a cystic parathyroidal adenoma with rapid growth induced by cinacalcet

Abstract

Background: 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. 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. 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.

Ectopic Retrolaryngeal Parathyroid Adenoma Detected by 18F-Ethylcholine PET/US Fusion Imaging

“…Cinacalcet medication was poorly tolerated by the patient, and rapid growth of hyperplastic parathyroid tissue has been described in the literature. 1 Therefore, re-cervicotomy was intended, but repeated conventional diagnostics still failed to reveal a parathyroid adenoma, so additional 18 F-ethylcholine PET/CT was performed. The superiority of 18 F-ethylcholine PET/CT over 99m Tc-MIBI scintigraphy has been described in several publications.…”

“…In expectation of physiologically localized parathyroid glands, the patient underwent surgery including right hemithyroidectomy, but the pHPT persisted. Cinacalcet medication was poorly tolerated by the patient, and rapid growth of hyperplastic parathyroid tissue has been described in the literature 1 . Therefore, re-cervicotomy was intended, but repeated conventional diagnostics still failed to reveal a parathyroid adenoma, so additional 18 F-ethylcholine PET/CT was performed.…”