Parathyroid adenoma apoplexy mimicking a thyroid bleeding cyst: a seemingly innocent condition that can be life-threatening
Primary hyperparathyroidism most commonly presents with hypercalcaemia. Rarely, parathyroid apoplexy or haemorrhage mimicking a thyroid bleeding cyst is the first presentation of a parathyroid adenoma. A woman presented with a sudden-onset painful ‘goitre’. Ultrasound showed a cystic nodule located...
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| Format: | Article |
| Language: | English |
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Bioscientifica
2023-12-01
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| Series: | Endocrinology, Diabetes & Metabolism Case Reports |
| Online Access: | https://edm.bioscientifica.com/view/journals/edm/2023/4/EDM22-0385.xml |
| _version_ | 1797392610778677248 |
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| author | Jasmine Van de Kerkhof Jacqueline Bijnens Frank De Geeter Catherine Dick Pascale De Paepe Annick Van den Bruel |
| author_facet | Jasmine Van de Kerkhof Jacqueline Bijnens Frank De Geeter Catherine Dick Pascale De Paepe Annick Van den Bruel |
| author_sort | Jasmine Van de Kerkhof |
| collection | DOAJ |
| description | Primary hyperparathyroidism most commonly presents with hypercalcaemia. Rarely, parathyroid apoplexy or haemorrhage mimicking a thyroid bleeding cyst is the first presentation of a parathyroid adenoma. A woman presented with a sudden-onset painful ‘goitre’. Ultrasound showed a cystic nodule located posterior to rather than in the right thyroid lobe, suggesting parathyroid adenoma bleeding. Biochemistry showed mild primary hyperparathyroidism. 99mTc-pertechnetate/sestamibi showed no uptake in the nodule, which was interpreted as a cold thyroid nodule. 18F-fluorocholine PET/CT showed uptake in the nodule, suggestive of a parathyroid adenoma. Persistent mild primary hyperparathyroidism complicated by nephrolithiasis and osteopenia favoured parathyroidectomy over a wait-and-see approach. The patient was referred for parathyroidectomy along with right thyroid lobectomy. Pathology showed an adenoma, with an eccentrically located cystic structure filled with red blood cells surrounded by a thickened fibrous capsule. In conclusion, cervical pain/haemorrhage with hypercalcaemia points to the diagnosis of parathyroid apoplexy, mimicking a thyroid bleeding cyst. Workup with ultrasound and, if available, 18F-choline PET/CT allows for timely surgery, minimizing the risk of recurrent and severe bleeding. |
| first_indexed | 2024-03-08T23:49:52Z |
| format | Article |
| id | doaj.art-80c1f8c09156417faa7d299925dd1177 |
| institution | Directory Open Access Journal |
| issn | 2052-0573 |
| language | English |
| last_indexed | 2024-03-08T23:49:52Z |
| publishDate | 2023-12-01 |
| publisher | Bioscientifica |
| record_format | Article |
| series | Endocrinology, Diabetes & Metabolism Case Reports |
| spelling | doaj.art-80c1f8c09156417faa7d299925dd11772023-12-13T11:39:03ZengBioscientificaEndocrinology, Diabetes & Metabolism Case Reports2052-05732023-12-01111410.1530/EDM-22-0385Parathyroid adenoma apoplexy mimicking a thyroid bleeding cyst: a seemingly innocent condition that can be life-threateningJasmine Van de Kerkhof0Jacqueline Bijnens1Frank De Geeter2Catherine Dick3Pascale De Paepe4Annick Van den Bruel5Department of ENT, H&N Surgery, General Hospital Sint-Jan, Bruges, BelgiumDepartment of ENT, H&N Surgery, General Hospital Sint-Jan, Bruges, BelgiumDepartment of Nuclear Medicine, General Hospital Sint-Jan, Bruges, BelgiumDepartment of ENT, H&N Surgery, General Hospital Sint-Jan, Bruges, BelgiumDepartment of Anatomopathology, General Hospital Sint-Jan, Bruges, BelgiumDepartment of Endocrinology, General Hospital Sint-Jan, Bruges, BelgiumPrimary hyperparathyroidism most commonly presents with hypercalcaemia. Rarely, parathyroid apoplexy or haemorrhage mimicking a thyroid bleeding cyst is the first presentation of a parathyroid adenoma. A woman presented with a sudden-onset painful ‘goitre’. Ultrasound showed a cystic nodule located posterior to rather than in the right thyroid lobe, suggesting parathyroid adenoma bleeding. Biochemistry showed mild primary hyperparathyroidism. 99mTc-pertechnetate/sestamibi showed no uptake in the nodule, which was interpreted as a cold thyroid nodule. 18F-fluorocholine PET/CT showed uptake in the nodule, suggestive of a parathyroid adenoma. Persistent mild primary hyperparathyroidism complicated by nephrolithiasis and osteopenia favoured parathyroidectomy over a wait-and-see approach. The patient was referred for parathyroidectomy along with right thyroid lobectomy. Pathology showed an adenoma, with an eccentrically located cystic structure filled with red blood cells surrounded by a thickened fibrous capsule. In conclusion, cervical pain/haemorrhage with hypercalcaemia points to the diagnosis of parathyroid apoplexy, mimicking a thyroid bleeding cyst. Workup with ultrasound and, if available, 18F-choline PET/CT allows for timely surgery, minimizing the risk of recurrent and severe bleeding.https://edm.bioscientifica.com/view/journals/edm/2023/4/EDM22-0385.xml |
| spellingShingle | Jasmine Van de Kerkhof Jacqueline Bijnens Frank De Geeter Catherine Dick Pascale De Paepe Annick Van den Bruel Parathyroid adenoma apoplexy mimicking a thyroid bleeding cyst: a seemingly innocent condition that can be life-threatening Endocrinology, Diabetes & Metabolism Case Reports |
| title | Parathyroid adenoma apoplexy mimicking a thyroid bleeding cyst: a seemingly innocent condition that can be life-threatening |
| title_full | Parathyroid adenoma apoplexy mimicking a thyroid bleeding cyst: a seemingly innocent condition that can be life-threatening |
| title_fullStr | Parathyroid adenoma apoplexy mimicking a thyroid bleeding cyst: a seemingly innocent condition that can be life-threatening |
| title_full_unstemmed | Parathyroid adenoma apoplexy mimicking a thyroid bleeding cyst: a seemingly innocent condition that can be life-threatening |
| title_short | Parathyroid adenoma apoplexy mimicking a thyroid bleeding cyst: a seemingly innocent condition that can be life-threatening |
| title_sort | parathyroid adenoma apoplexy mimicking a thyroid bleeding cyst a seemingly innocent condition that can be life threatening |
| url | https://edm.bioscientifica.com/view/journals/edm/2023/4/EDM22-0385.xml |
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