Unsuspected Parathyroid Cysts Diagnosed by Measurement of Thyroglobulin and Parathyroid Hormone Concentrations in Fluid Aspirates

Pacini, Furio; Antonelli, Alessandro; Lari, Riccardo; Gasperini, Lucia; Baschieri, L; Pinchera, Aldo

doi:10.7326/0003-4819-102-6-793

Cited by 65 publications

(36 citation statements)

References 5 publications

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“…The diagnosis can be established by elevated levels of PTH in the aspirated fluid. 38 Thyroid cysts usually yield a yellowish or bloody aspirate with high levels of Tg and undetectable levels of PTH, 39 whereas branchial cysts yield a yellowish and viscous aspirate. Nonfunctioning PC have cystic fluid PTH concentrations ranging from several hundred to over 400,000 pg/ml with normal serum PTH concentration.…”

Section: Diagnosismentioning

confidence: 99%

Diagnostic and therapeutic review of cystic parathyroid lesions

Pontikides¹,

Karras²,

Kaprara³

et al. 2012

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BAcKGrOUND: Parathyroid cysts (Pc) are uncommon entities in routine clinical practice. The vast majority are nonfunctioning and are commonly present as asymptomatic nodular cervical lesions. Pc should be considered in the differential diagnosis of an asymptomatic neck mass. Large Pc can manifest with compressive symptoms of the surrounding tissues. OBJEcTIVE: The aim of this study is to describe nine new cases of Pc and review the current literature regarding the clinical presentation, the aetiopathology, the diagnostic procedures, as well as the therapeutic approaches for this relatively rare clinical entity. METHODs-PATIENTs: We present nine new patients (7 females and 2 males) diagnosed with Pc, which in three were ectopic. The diagnosis of Pc was based on the elevated levels of PTH in the cysts fluid. six of the patients had nonfunctioning parathyroid lesions, while the other three had functioning ones. Patients with functioning Pc had elevated serum calcium and PTH levels. Five out of nine of the cases had no symptoms, while two patients had compressive symptoms and the other two had signs and symptoms of hypercalcaemia. Needle aspiration (NA) was performed in five out of six patients with nonfunctioning Pc. surgery was the treatment in all three patients with functioning Pc. rEsULTs: remission after NA was achieved in four out of five patients with non-functioning Pc (follow-up time: 17.7±2.3 months). In two of them, two and three aspirations were needed. One patient with nonfunctioning Pc submitted to surgery with no previous NA. Patients with functioning Pc maintained remission after surgery (mean follow-up time: 22.1±2.9 months). In one of them, a second surgery was performed due to the co-existence of an ectopic parathyroid adenoma. cONcLUsIONs: The diagnosis of a Pc can be established by finding high levels of PTH in the fluid collected by the aspiration of the cyst. PTH and ca levels in the serum can differentiate functioning from nonfunctioning Pc. The treatment of HORMONES 2012, 11(4):410-418 Review

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Section: Diagnosismentioning

confidence: 99%

Diagnostic and therapeutic review of cystic parathyroid lesions

Pontikides¹,

Karras²,

Kaprara³

et al. 2012

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“…In presence of a cystic mass in the neck in or around the thyroid, a crystal clear fluid in the aspirate should raise suspicion of a parathyroid cyst. A high PTH level in the fluid confirms the diagnosis of parathyroid cyst (30,31). A biochemical evaluation should be completed with parathyroid hormone and calcium in blood to rule out a functional parathyroid cyst.…”

Section: Discussionmentioning

confidence: 91%

Parathyroid cysts: the Latin-American experience

et al. 2016

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Background: Parathyroid cyst is an infrequent and unsuspected disease. There are more than 300 hundred cases reported in the world literature, a few of them are from Latin America. The experience of our centers and a review of the cases are presented.Methods: Case report of a series of patients with parathyroid cyst from our institutions according to the CARE guidelines (Case Reports). A search of Medline, Embase, BIREME (Biblioteca Regional de Medicina) LILACS (Literatura Latinoamericana y del Caribe en Ciencias de la Salud), Google Scholar and Scielo (ScientificElectronic Library on Line) databases and telephonic or email communications with other experts from LatinAmerica was performed .Results: Six patients with parathyroid cyst were found in our centers in Colombia. Most of them were managed with aspiration of the cyst. Two of them required surgery. Only one case was functional. Twelve reports from Latin America were found for a total of 18 cases in our region adding ours.

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“…PTH concentration in the cystic fluid of non-functioning PCs ranges from several hundred to over 400,000 pg/ml with normal serum PTH levels [49]. Thyroid cysts usually yield a yellowish or bloody aspirate with high thyroglobulin and undetectable PTH levels,whereas a yellowish and viscous aspirate is characteristic of branchial cysts [50].…”

Section: Discussionmentioning

confidence: 99%

Cystic parathyroid glands in MEN1: A rare entity?

et al. 2016

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Approximately 300 cases of sporadic parathyroid cyst (PCs) have been reported to date. Only two cases have been described in MEN1 so far. Detection by imaging could be challenging, especially in multiglandular primary hyperparathyroidism (HPT) and clinical outcome could be different. During the period 1990-2014, 71 MEN1 patients were operated for primary hyperparathyroidism in our centre. We report three cases of PCs in MEN1 patients affected by HPT, who underwent a total or subtotal parathyroidectomy with transcervical thymectomy. In our series, all three patients had an unsatisfactory postoperative course, at variance with the high percentage (over 90 %) of long-term success in MEN1 patients operated at our centre. One patient affected by cystic degeneration of all the four parathyroid glands reported persistent hypoparathyroidism, despite autografts of parathyroid tissue. For the other two cases, surgery failed to cure hyperparathyroidism, perhaps because of the presence of undetected ectopic parathyroid tissue. In the context of a multiglandular disease such as MEN1 syndrome, PCs seem rare but our experience shows about a 4 % incidence. Furthermore their presence, even in expert hands, could affect the preoperative identification of the parathyroid glands due to the difficult differential diagnosis between PC and other cystic lesions of the neck, and intraoperative detection of the glands as well as the postoperative outcome.

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Unsuspected Parathyroid Cysts Diagnosed by Measurement of Thyroglobulin and Parathyroid Hormone Concentrations in Fluid Aspirates

Cited by 65 publications

References 5 publications

Diagnostic and therapeutic review of cystic parathyroid lesions

Diagnostic and therapeutic review of cystic parathyroid lesions

Parathyroid cysts: the Latin-American experience

Cystic parathyroid glands in MEN1: A rare entity?

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