Sarcoid granulomas in the parathyroid gland - a case of dual pathology: hypercalcaemia due to a parathyroid adenoma and coexistent sarcoidosis with granulomas located within the parathyroid adenoma and thyroid gland

Balasanthiran, Anjali; Sandler, Belinda; Amonoo-Kuofi, Kwamena; Swamy, Rajiv; Kaniyur, S; Kaplan, Felicity

doi:10.1507/endocrj.k10e-028

Cited by 11 publications

(4 citation statements)

References 12 publications

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“…A hand search of article bibliographies was also performed with the ISI Thompson Web of Knowledge Citation report, enabling further articles to be retrieved. From the initial electronic search of 185 articles for possible inclusion, 27 articles were retained following title and abstract reviews; these articles reported on a total of 96 patients with inflammatory diseases of the parathyroid gland, including parathyroiditis ( n = 15), lymphocytic infiltrate ( n = 69), sarcoidosis of the parathyroid gland ( n = 6), tuberculosis ( n = 14), and granulomatous disease ( n = 2) 10–36 . The inclusion criterion was unambiguous evidence of inflammatory processes of the parathyroid gland in the form of a histological description.…”

Section: Methodsmentioning

confidence: 99%

Inflammatory diseases of the parathyroid gland

Talat¹,

Díaz‐Cano

Schulte³

2011

Histopathology

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Talat N, Diaz‐Cano S & Schulte K‐M (2011) Histopathology59, 897–908 Inflammatory diseases of the parathyroid gland Aims: Inflammatory disorders of the parathyroid gland are very rare as compared with those of other endocrine organs. The aim of this study was to provide the first systematic review of this condition. Methods and results: A 42‐year‐old patient underwent surgery for recurrent secondary hyperparathyroidism. Histology showed hyperplastic parathyroiditis defined by a mixed inflammatory infiltrate with active germinal centres. Molecular markers revealed significant upregulation of CD68 in an ischaemic background (hypoxia‐inducible factor 1 upregulation) with mitochondrial reaction (malate dehydrogenase 2 upregulation) and hyperparathyroidism (carbonic anhydrase 4 upregulation). Our case demonstrates true intraparathyroid inflammation with terminal B‐cell differentiation. We searched PubMed, ISI Thompson and Google Scholar up to January 2011, using the terms ‘parathyroiditis’, ‘inflammation of parathyroid gland’, ‘lymphocytic infiltrate’, ‘tuberculosis of the parathyroid’, ‘sarcoidosis’, and ‘graulomatous inflammation’. Three autopsy series, 27 articles and 96 case reports with inflammatory parathyroid disorders were identified. Autopsy series showed lymphocytic infiltrates in up to 16% of all cases. The entire material reported lymphocytic infiltrates (n = 69), parathyroiditis with germinal centres (n = 15), sarcoidosis (n = 6), tuberculosis (n = 4), and other granulomatous diseases (n = 2). Conclusions: Distinct inflammatory and granulomatous processes in the parathyroid gland are rare. Scanty lymphocytic infiltrates are common, and occur in generalized inflammatory conditions or venous congestion. We note the surprising absence of an association between histological proof of parathyroiditis and hypoparathyroidism.

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Section: Methodsmentioning

confidence: 99%

Inflammatory diseases of the parathyroid gland

Talat¹,

Díaz‐Cano

Schulte³

2011

Histopathology

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“…Parathyroid adenomas were histologically confirmed in six of these seven cases, and in the remaining case, the serum PTH was elevated, and hyperplasia of the parathyroid gland was demonstrated without evidence of an adenoma 1–5. Histologic examination revealed non-caseating granulomas within the adenoma in five cases,1 3–5 adjacent to the adenoma in one case2 and within the hyperplastic parathyroid tissue in the one case in which no adenoma was found 2. In all cases that reported laboratory data, the serum calcium level was increased, serum 1,25(OH) 2 vitamin D was elevated or at the upper limits of normal, serum 25(OH) vitamin D was low and the serum PTH level was elevated.…”

Section: Discussionmentioning

confidence: 81%

Rare case of parathyroid gland sarcoidosis presenting with hypercalcaemia

et al. 2019

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Sarcoidosis of the parathyroid gland is a rare occurrence. Parathyroid sarcoidosis is usually associated with parathyroid adenomas, and, therefore, hypercalcaemia is a common presentation of this entity. We present a case of parathyroid sarcoidosis and review the world literature regarding this rare condition. A woman with a history of diffuse large B cell lymphoma underwent a surveillance positron emission tomography scan that showed increased fluorodeoxyglucose uptake in multiple thoracic and abdominal lymph nodes and in a left upper extremity soft tissue mass. Biopsy of the soft tissue mass showed non-caseating granulomas consistent with sarcoidosis. Blood work showed a serum calcium of 11.1 mg/dL with an intact serum parathyroid hormone of 92 pg/dL. Primary hyperparathyroidism was suspected. A neck ultrasound and sestamibi parathyroid scintigraphy demonstrated a parathyroid nodule. She underwent surgical resection, and the histopathology revealed a parathyroid adenoma and non-caseating granulomata consistent with a diagnosis of sarcoidosis.

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“…Hypercalcemia could be caused by malignancies, primary hyperparathyroidism, familial hypocalciuric hypercalcemia, and granulomatous diseases 1 . In fact, patients with sarcoidosis were reported to develop hypercalcemia due to various causes including hyperparathyroidism, inappropriate parathyroid hormone–related peptide production, elevated 1,25-dihydroxy vitamin D3 production, and renal insufficiency 2,3 . Therefore, measurement of serum parathyroid hormone (PTH) and 25-OH vitamin D3 levels was recommended.…”

Section: Case Presentationmentioning

confidence: 99%

Coexistence of Parathyroid Adenoma, Sarcoidosis, and Hypercalcemia

et al. 2020

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A 51-year-old housewife presented with a history of fever, muscular weakness, morning cough, dyspnea, and back pain. She had been diagnosed with sarcoidosis for 8 years and was treated with prednisolone and azathioprine. On examination, evidence of multisystem involvement with sarcoidosis was found. Initial laboratory findings revealed inflammation (erythrocyte sedimentation rate, 41 mm/h; reference range, <20 mm/h), hypercalcemia (serum calcium, 15.7 mg/dL; reference range, 8.6-10.2 mg/ dL), hypercalciuria (urinary calcium, 305 mg/24 hours; reference range, 100-250 mg/24 hours), and thrombocytosis (platelet count, 463,000/μL; reference range, 150,000-450,000/μL). Serum phosphorus (2.7 mg/dL; reference range, 2.5-5 mg/dL), alkaline phosphatase (264 IU/L; reference range, 64-306 IU/L), and 24-hour urinary creatinine (588 mg/24 hours; reference range, 600-1800 mg/ 24 hours) were all within the normal limits.Hypercalcemia could be caused by malignancies, primary hyperparathyroidism, familial hypocalciuric hypercalcemia, and granulomatous diseases. 1 In fact, patients with sarcoidosis were reported to develop hypercalcemia due to various causes including hyperparathyroidism, inappropriate parathyroid hormone-related peptide production, elevated 1,25-dihydroxy vitamin D3 production, and renal insufficiency. 2,3 Therefore, measurement of serum parathyroid hormone (PTH) and 25-OH vitamin D3 levels was recommended. Provided that no aberrations in the 25-OH vitamin D3 level (29.3 ng/mL; reference range, 20-100 ng/mL) were observed, the patient's elevated PTH level (257 ng/mL; reference range, 10-65 ng/mL) confirmed hyperparathyroidism as the From the

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Sarcoid granulomas in the parathyroid gland - a case of dual pathology: hypercalcaemia due to a parathyroid adenoma and coexistent sarcoidosis with granulomas located within the parathyroid adenoma and thyroid gland

Cited by 11 publications

References 12 publications

Inflammatory diseases of the parathyroid gland

Inflammatory diseases of the parathyroid gland

Rare case of parathyroid gland sarcoidosis presenting with hypercalcaemia

Coexistence of Parathyroid Adenoma, Sarcoidosis, and Hypercalcemia

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