ABSTRACT
Primary hyperparathyroidism due to ectopic parathyroid adenomas can pose diagnostic and management challenges, especially when imaging studies have localised the lesions to different sites. We report a case of symptomatic hypercalcaemia due to a mediastinal parathyroid adenoma. Ultrasonography identified a nodule posterior to the right thyroid gland. However, computed tomography and technetium-99m sestamibi scintigraphy revealed an ectopic parathyroid adenoma located in the anterior mediastinum. The adenoma was successfully removed through a median sternotomy. However, postoperatively, the patient developed prolonged symptomatic hypocalcaemia, possibly due to suppression of the normal parathyroid gland function, although the presence of concomitant hungry bone syndrome was possible. The histopathology of the mediastinal mass was consistent with a parathyroid adenoma.
Subject(s)
Mediastinal Neoplasms/diagnosis , Mediastinal Neoplasms/surgery , Parathyroid Neoplasms/diagnosis , Parathyroid Neoplasms/surgery , Calcium/blood , Female , Humans , Hypercalcemia/etiology , Hyperparathyroidism/diagnosis , Hypocalcemia/drug therapy , Hypocalcemia/etiology , Mediastinal Neoplasms/diagnostic imaging , Middle Aged , Parathyroid Glands/pathology , Parathyroid Neoplasms/diagnostic imaging , Postoperative Complications , Technetium Tc 99m Sestamibi/pharmacology , Tomography, X-Ray Computed , UltrasonographySubject(s)
Adrenal Gland Diseases/diagnostic imaging , Adrenal Glands/diagnostic imaging , Calcinosis/diagnostic imaging , Tuberculosis, Endocrine/diagnostic imaging , Adrenal Gland Diseases/surgery , Adrenal Glands/surgery , Adrenalectomy , Aged , Diagnosis, Differential , Female , Humans , Male , Middle Aged , Mycobacterium tuberculosis/isolation & purification , Tomography, X-Ray Computed , Tuberculosis, Endocrine/surgeryABSTRACT
INTRODUCTION: Adrenocortical carcinomas are rare. This case series is reported to give an overview of how adrenocortical carcinoma is currently managed in the UK. PATIENTS AND METHODS: A retrospective review was made of case notes from patients with adrenocortical carcinomas presenting to the authors (TWJL, RDB, BJH, and DS-C) over the past 10 years in Newcastle, Sheffield and Cardiff. RESULTS: Newcastle treated twelve, Sheffield eleven and Cardiff seven cases. The median follow-up was 25.5 months (range, 1-102 months). All tumours were greater than 5 cm in diameter. The majority presented with symptoms of hormone excess. Adrenalectomy was performed in 83% - this was radical in 30% and followed by excision of recurrence in 13%. Adjuvant mitotane was given in 64% of patients, in combination with cytotoxic chemotherapy in 20%. One-third of patients did not receive any adjuvant therapy. There was no significant difference in survival between the three centres. The majority of patients (57%) died during the period of follow-up of this study. The median survival was 37 months (range, 2-102 months). CONCLUSIONS: The size of tumour, stage and mode of presentation, age and overall survival of patients in this study are comparable to published series of adrenocortical carcinomas from major endocrine surgical centres world-wide. Despite controversies about benefits, adjuvant mitotane was used in the majority of cases, whereas cytotoxic chemotherapy was only used in the minority. The exact role of adjuvant therapy in the management of adrenocortical carcinoma is not as well established as for other more common malignancies. Establishing a database for adrenocortical carcinomas in the UK would contribute to our understanding of the management of this disease.