Tuberculous Granulomatous Inflammation Associated with Adenoma of Parathyroid Gland Manifesting as Primary Hyperparathyroidism

Abstract

A 36-year-old female presented with generalized bone pain, muscular weakness and enlarged cervical lymph nodes. The biochemical findings and skeletal survey was suggestive of primary hyperparathyroidism (PHPT). CT of neck and thorax showed enlarged multiple lymph nodes in the cervical and superior mediastinal region. With a diagnosis of PHPT she underwent cervical exploration and excision of enlarged right inferior parathyroid gland along with biopsy of nodes were done. Histopathology revealed the features of right parathyroid adenoma with few foci of epithelioid granuloma and granulomatous lymphadenitis. AFB smear and culture sensitivity was negative. A positive PCR for Mycobacterium tuberculosis of the homogenates of parathyroid tumor confirmed tuberculous inflammation within the parathyroid adenoma. To the best of our knowledge this is the first reported case of parathyroid adenoma associated with tuberculous pathology in a case of PHPT.

Granulomatous infiltration of a parathyroid adenoma presenting as primary hyperparathyroidism in a woman: a case report

“…In these latter cases, the parathyroid glands had been demonstrated to be infiltrated by granulomatous inflammation of tuberculosis within parathyroid adenomas. In the report from India and in a recent report from England, in addition to granulomatous inflammation of the parathyroid adenoma, inflammation of the lymph nodes had been detected [7,9]. Our patient showed no pathology in the lymph nodes on either pathological examination or imaging, although her two excised lymph nodes showed findings consistent with reactive hyperplasia.…”

“…Hypercalcemia due to co-existing parathyroid adenoma and sarcoidosis had been published before in the literature [3-6]; however, few cases of granulomatous inflammation within the parathyroid adenoma had been reported [7-9]. In these latter cases, the parathyroid glands had been demonstrated to be infiltrated by granulomatous inflammation of tuberculosis within parathyroid adenomas.…”

“…Our patient showed no pathology in the lymph nodes on either pathological examination or imaging, although her two excised lymph nodes showed findings consistent with reactive hyperplasia. Kar and colleagues [7] confirmed tuberculosis with a positive PCR for Mycobacterium tuberculosis , and Sadideen and colleagues [9] showed tuberculosis by the presence of occasional acid-fast bacilli in such cases. As it happened in our case, Jacob et al .…”

Atypical ultrasound features of parathyroid tumours may bear a relationship to their clinical and biochemical presentation

“…This patient did not have any other focus of tuberculosis. Tuberculosis of the parathyroid gland is extremely rare and the literature on this entity is limited to a few case reports [10, 11]. To the best of our knowledge, there is no literature in the English language on the ultrasound appearance of tuberculosis of the parathyroid gland.…”

Non‐functioning mediastinal parathyroid adenoma with sarcoid‐like granulomatous lymphadenopathy

“…Kinoshita et al (11) reported a patient who was on steroid therapy for sarcoidosis and who later developed a parathyroid adenoma. Others have reported tuberculous granulomatous inflammation (12) and necrotizing granulomatous inflammation (13) associated with parathyroid adenoma. However, all these patients—unlike the present case—had manifestations of primary hyperparathyroidism.…”