How Atypical Adenoma Wore the Mask of Carcinoma in a Young Man with Skeletal Crisis
https://doi.org/10.15605/jafes.041.S1
- Author:
Chee Kit Tee
1
;
Yong Siang Ng
1
;
Noor Hafis Md Tob
1
;
Norhaliza Mohd Ali
1
Author Information
1. Hospital Sultanah Aminah
- Publication Type:Journal Article
- MeSH:
Carcinoma;
Adenoma
- From:
Journal of the ASEAN Federation of Endocrine Societies
2026;41(S1):76-77
- CountryPhilippines
- Language:English
-
Abstract:
Introduction:Atypical parathyroid adenoma is a rare cause of primary
hyperparathyroidism and represents a borderline entity
between benign adenoma and parathyroid carcinoma. Due
to overlapping clinical, biochemical, and imaging features
with carcinoma, diagnosis can be challenging and relies
on histopathological evaluation to guide management and
follow-up.
Case:A 25-year-old male presented with a 3-month history of
generalized bone pain and lethargy, with significant weight
loss of 17 kg over 7 months. He denied headache, visual
disturbance, or hypoglycemic episodes. There was no known family history of endocrine tumors. Examination revealed
a palpable right-sided neck mass. Biochemical evaluation
showed severe primary hyperparathyroidism with
marked hypercalcemia (4.12 mmol/L), hypophosphatemia
(0.6 mmol/L), markedly elevated intact parathyroid
hormone (137 pmol/L) and alkaline phosphatase (1,958
U/L). Thyroid function was normal. Neck ultrasound
demonstrated a right TIRADS 4 lesion, and fine-needle
aspiration suggested parathyroid tissue. Sestamibi scan
localized a hyperfunctioning right inferior parathyroid
gland measuring 2.1 × 1.7 × 3.3 cm. During admission, he
sustained low-impact fragility fractures of the left femur
and humerus after a fall. Preoperatively, management of
hypercalcemia proved challenging. Despite aggressive
medical therapy and intensive intravenous hydration
with up to 6 liters of normal saline per day, serum calcium
levels remained persistently exceeding 3.0 mmol/L. He
underwent right hemithyroidectomy with excision of the
right inferior parathyroid gland. The postoperative course
was complicated by hungry bone syndrome, necessitating
intravenous calcium gluconate infusion for 1 week.
Histopathological examination confirmed the diagnosis
of an atypical parathyroid adenoma. On postoperative
follow-up, serum calcium and phosphate levels normalized
while he remained on calcium carbonate and calcitriol
supplementation.
Conclusion:Severe primary hyperparathyroidism in young patients
may indicate aggressive parathyroid pathology. Atypical
parathyroid tumors can mimic carcinoma, and diagnosis
requires histopathology with long-term follow-up due to
uncertain malignant potential.
- Full text:202608041118344022EP_A104.pdf
