Non-Functional Parathyroid Adenoma Presenting as a Massive Cervical Hematoma: A Case Report

Shim, Woo Sub; Kim, In Kyeong; Yoo, Seung Du; Kim, Dong Hwal

doi:10.3342/ceo.2008.1.1.46

Cited by 16 publications

(8 citation statements)

References 11 publications

(18 reference statements)

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“…Scintigraphy is less widely used and in cases where the parathyroid sestamibi scan has been available, interestingly, the majority have not shown increased uptake in the area of concern. (2) (3) (6) (7). In our case, scintigraphy was a useful adjunct to confirming the diagnosis of parathyroid adenoma as there was a clear area of increased uptake.…”

Section: Discussionmentioning

confidence: 54%

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Spontaneous cervical haemorrhage of a parathyroid adenoma

Ulrich

Knee

Todd

2015

Endocrinology, Diabetes &Amp; Metabolism Case Reports

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SummaryHaemorrhage of a parathyroid adenoma is a rare clinical presentation. This report describes a previously fit and well 54-year-old woman who presented with acute neck swelling and pain with an overlying ecchymosis. Admission laboratory tests revealed a raised parathyroid hormone and hypercalcaemia. A computed tomography (CT) scan showed widespread anterior cervical haemorrhage and a lesion at the inferior pole of the left thyroid gland. A working diagnosis of spontaneous haemorrhage from a parathyroid adenoma was made. As she was haemodynamically stable, she was treated conservatively with a period of observation in hospital to monitor for signs of neck organ compression. Follow-up imaging with CT, ultrasound and sestamibi confirmed the likely source of haemorrhage as a parathyroid nodule with significant vascularity. The diagnosis was confirmed on histopathological analysis after elective surgical exploration of the neck 6 months after her presentation. This revealed a benign parathyroid adenoma with evidence of acute and chronic bleeding. The patient made a full recovery with immediate normalisation of her biochemistry post-operatively. Despite developing a hoarse voice in the immediate post-operative period, this resolved completely within 1 month. This case report provides further evidence to support a minimal delay for elective surgery after conservative management to reduce the risks associated with recurrent bleeding.Learning points Haemorrhage of a parathyroid adenoma should be a differential for all cases of acute cervical swelling or ecchymosis with no precipitating factor.The clerking should identify any risk factors for endocrine disease.Blood tests to screen for abnormal parathyroid biochemistry should be performed on admission.Detailed imaging of the neck is essential to identify the source of haemorrhage and risk of compression to vital neck organs.Conservative management is a suitable option for patients who remain haemodynamically stable but all should undergo a period of observation in hospital.Conservatively managed patients should be considered for definitive surgical exploration within a month of presentation to avoid the risks of recurrent bleeding.

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Section: Discussionmentioning

confidence: 54%

“…Shim et al . (7), however, reports a non-functional adenoma which could be explained by either tissue necrosis secondary to cystic degeneration or pressure from the haematoma compressing surrounding blood flow.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous cervical haemorrhage of a parathyroid adenoma

Ulrich

Knee

Todd

2015

Endocrinology, Diabetes &Amp; Metabolism Case Reports

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“…Second, PTH may be secreted into the lumen of the cyst instead of the bloodstream. Third, the pressure caused by the hematoma may interfere with blood flow around the adenoma [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

Parathyroid adenoma causing spontaneous cervical hematoma: two case reports

et al. 2015

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BackgroundAlthough spontaneous rupture of a cervical parathyroid adenoma with extracapsular hemorrhage is rare, it may cause cervical and mediastinal hematoma, leading to potentially fatal consequences.Case presentationThe first case was a 76-year-old Asian female who presented with pharyngeal discomfort and anterior chest ecchymosis. Endoscopic investigation showed submucosal hemorrhage in the pharynx and larynx. The second case was a 62-year-old Asian male who presented with anterior chest ecchymosis and suspected of a ruptured blood vessel. Both cases were diagnosed parathyroid adenoma with extracapsular bleeding by hypercalcemia, high levels of intact parathyroid hormone and presence of a nodule behind the thyroid. Both cases were treated with excision of tumor 7 months after initial presentation. After surgery, serum calcium and parathyroid hormone levels had decreased to normal level in both cases.ConclusionExtracapsular bleeding of a parathyroid adenoma should be considered in the differential diagnosis of non-traumatic neck hematoma.

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“…However, some patients are asymptomatic and present with normal serum levels of PTH and calcium. [3][4][5]7) Because of its rarity, a spontaneous rupture of a parathyroid adenoma is difficult to detect in patients who lack a diagnosis of adenoma, hyperplasia or pathologies of the parathyroid glands. The first case 1) was diagnosed by autopsy.…”

Section: Discussionmentioning

confidence: 99%

“…Over the last 80 years, approximately 20 cases of acute hemorrhage resulting from the spontaneous rupture of the parathyroid glands have been reported in the English literature. A previous study reported that the causes of these hemorrhages include parathyroid glands that are enlarged by adenomas, [1][2][3][4][5][6][7][8][9] primary or secondary hyperplasia, [10][11][12] cysts [13][14][15] and carcinomas. 16) Some authors report that blood supplies may occasionally fail to meet the increased demands caused by these lesions.…”

Section: Discussionmentioning

confidence: 99%