Ectopic mediastinal parathyroid adenoma: a cause of acute pancreatitis

Imachi, Hitomi; Murao, Koji; Kontani, Keiichi; Yokomise, Hiroyasu; Miyai, Yumi; Yamamoto, Yuka; Kushida, Yoshio; Haba, Reiji; Ishida, Toshihiko

doi:10.1007/s12020-009-9223-x

Cited by 14 publications

(7 citation statements)

References 18 publications

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“…However, PHPT causes less than 1% of all cases of acute pancreatitis, and the incidence of acute pancreatitis in hyperparathyroidism varies from 1.5% to 7% 3,7…”

Section: Discussionmentioning

confidence: 99%

Parathyroid Cyst Presenting as Acute Pancreatitis: Report of a Case

et al. 2013

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We report the first case of hypercalcemia-induced acute pancreatitis caused by a functioning parathyroid cyst in a 67-year-old man. Laboratory investigation revealed increased serum amylase and lipase, increased serum ionized calcium and parathyroid hormone (PTH) levels, and decreased serum phosphate, indicating pancreatitis and primary hyperparathyroidism (PHPT). Abdominal computed tomography (CT) revealed mild swelling of the pancreatic head with peri-pancreatic fat infiltration and fluid collection around the pancreatic tail. Ultrasonography and CT of the neck showed a cystic lesion at the inferior portion of the left thyroid gland, suggesting a parathyroid cyst. There was no evidence of parathyroid adenoma by 99mTc sestamibi scintigraphy. PHPT caused by a functioning parathyroid cyst was suspected. The patient underwent surgical resection of the functioning parathyroid cyst owing to his prolonged hypercalcemia. At 3 weeks after the operation, his serum levels of PTH, total calcium, ionized calcium, inorganic phosphate, amylase, and lipase were normalized. At the follow-up examinations, he has remained asymptomatic.

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“…However, PHPT causes less than 1% of all cases of acute pancreatitis, and the incidence of acute pancreatitis in hyperparathyroidism varies from 1.5% to 7% 3,7…”

Section: Discussionmentioning

confidence: 99%

Parathyroid Cyst Presenting as Acute Pancreatitis: Report of a Case

et al. 2013

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“…The frequencies of skeletal and renal complications were similar between ectopic carcinomas and adenomas ( Table 2), but lower than that of orthotopic carcinomas, while higher than that of benign parathyroid hyperparathyroidism (<20% renal impairment and <10% skeletal abnormalities) (5,42). Although neither we nor Mendoza et al (41) report acute pancreatitis in ectopic PAs, there are a few case reports describing mediastinal PAs with the presentation of acute pancreatitis (51,52). Therefore, large-scale cohort studies are needed to investigate the association between pancreatitis and PCs.…”

Section: Resultsmentioning

confidence: 64%

Persistent Hypercalcemia Crisis and Recurrent Acute Pancreatitis Due to Multiple Ectopic Parathyroid Carcinomas: Case Report and Literature Review of Mediastinal Parathyroid Carcinoma

et al. 2020

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Mediastinal parathyroid carcinoma (PC) is a rare entity in primary hyperparathyroidism. The aim of this report is to demonstrate a case of mediastinal PC, and to provide a systemic literature review of this rare condition. A 34-year-old woman who had already undergone two cervical operations for hyperparathyroidism suffered from another recurrence, presenting with recurrent acute pancreatitis and persistent hypercalcemic crisis. Technetium-99 methoxyisobutylisonitrile imaging (MIBI) and computed tomography scanning (CT) identified three possible parathyroid tumors, one of which was the recurrence of residual tumor locating in the thyroid region, while the other two were ectopic tumors locating in the suprasternal fossa and thymus region, respectively. Pathological examination confirmed the diagnosis of PC. We conducted a systemic literature review by searching the PubMed MEDLINE from 1951 to 2019 for studies of all types in the English language only, using terms "mediastinal, mediastinum, parathyroid, carcinoma." Including our reported case, a total of 21 cases with ectopic mediastinal PCs were assessed for demographic data, tumor location and size, biochemical findings, and symptomatology, etc. Two thirds of the patients were men, with a mean age of 44 years old, a mean serum calcium of 14.2 mg/dl, and a mean serum intact parathyroid hormone of 1,216 pg/ml. We identified 89.5% of carcinomas in the anterosuperior mediastinum, and 10.5% in the middle mediastinum, with a mean diameter of 54 mm, and a mean weight of 216 g. MIBI and CT were the most commonly used methods to localize these mediastinal tumors, with 69.2 and 100% sensitivity, respectively. Half of the patients underwent more than one operation. Diagnosis and treatment of mediastinal PCs represent a challenge. Early suspicion, appropriate preoperative localization studies, and the cooperation of endocrinologists and surgeons are crucial in the effective management.

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“…If hypercalcaemia is detected, the parathormone level must be measured and an ultrasonography of the neck should be performed. In case of suspicious findings in these examinations, an MRI of the neck and the mediastinum is indicated to investigate the possibility of multiple or ectopic adenomas [ 6 ], [ 11 ], [ 15 ]. As a matter of course computed tomography and scintigraphy are contraindicated due to potential fetal impairment [ 10 ], [ 15 ], [ 17 ].…”

Section: Discussionmentioning

confidence: 99%