Original ArticleParathyroid Lipoadenomas: A Rare Cause of Primary Hyperparathyroidism
Section snippets
INTRODUCTION
Primary hyperparathyroidism (HPT) is a common disease, estimated to be the third most diagnosed endocrine disorder (1). The clinical presentation usually consists of an elevated serum calcium level in an otherwise asymptomatic patient (2). The normal parathyroid gland contains chief cells and a few oxyphil cells arranged in a branching, cordlike configuration, surrounded by stromal tissue. Chief cells are the main source of parathyroid hormone (PTH), and chief cell parathyroid adenomas are the
MATERIAL AND METHODS
After approval from the Mayo Foundation Institutional Review Board, we searched the diagnostic medical record index, surgical index, and pathology database for parathyroid lipoadenomas. During the period when our cases were identified (1971 to 2001), our institution registered 9,530 cases of HPT and performed 7,120 parathyroidectomies. These numbers did not include patients with clinically unrecognized persistent hypercalcemia, who constitute 16% of patients with HPT in the community (29).
Clinical Profile
Three women (60%) and 2 men (40%) were identified, with a mean age of 62 years (range, 51.5 to 83) at diagnosis. Only 1 patient presented with possible hypercalcemia-related symptoms (history of left hip fracture and kidney stones). Another patient had asymptomatic kidney stones and osteopenia noted on radiography, and a third patient had only evidence of osteopenia on radiography. Bone densitometry was not performed in any patient. The mean duration (± SD) of clinically recognized hypercalcemia
DISCUSSION
Primary HPT due to a parathyroid lipoadenoma was associated with modest hypercalcemia and few clinical symptoms in our cohort. Only 1 study subject presented with possible hypercalcemia-related symptoms in the form of renal stones and a hip fracture. Thus, the clinical presentation is similar to that seen in patients with primary HPT due to the typical chief cell parathyroid adenoma. Although the small number of study subjects may bias any conclusion about the clinical presentation, this cohort
CONCLUSION
Overall, parathyroid lipoadenomas are a rare cause of primary HPT. Their clinical features are characterized by modest hypercalcemia without symptoms, similar to typical primary HPT due to chief cell parathyroid adenomas. The difficulty of preoperative localization of parathyroid lipoadenomas with use of nuclear scans may be due to the high stromal fat content, and the additional use of ultra-sonography may be beneficial. Further studies evaluating the trends of parathyroid pathologic features
ACKNOWLEDGMENT
We thank Michelle Papaconstandinou for assistance with manuscript preparation.
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