Unusual Presentations of Functional Parathyroid Cysts

A Case Series and Review of the Literature

Youssef El-Housseini; Martin Hübner; Ariane Boubaker; Jan Bruegger; Maurice Matter; Olivier Bonny

J Med Case Reports. 2017;11(333)

Background

Cysts of the parathyroid gland are traditionally classified as either non-functional or as functional and may represent up to 5% of all cystic tumors of the anterior neck.^[1] The majority of parathyroid cysts are non-functional, generally discovered during thyroid or cervical investigations, and are not associated with primary hyperparathyroidism.^[2] By contrast, functional cysts induce symptoms and signs of primary hyperparathyroidism. Their fluid contains high concentrations of parathyroid hormone (PTH), which may induce parathyroid crisis in case of rupture. Here, we report three cases of patients with functional parathyroid cysts, with atypical presentation, and we propose a simple investigation and treatment algorithm.

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Table 1. Clinical characteristics of the patients
Age, sex (years)	Clinical symptoms	Serum calcium (mg/dl)	Serum PTH (pg/ml)	Intracystic PTH (pg/ml)	Detection technique	Position of the parathyroid cyst	Size (cm)	Treatment	Serum PTH 1 day after surgery (pg/ml)
87, F	Confusion Dysphagia Dehydration	13.84	305	n.d.	MIBI negative and CT scan positive	Upper right	3.5 × 3 × 2	Surgical resection	8
31, F	Hypertensive crisis with transient ischemic attack	10.76	259	n.d.	MIBI positive and US positive	Lower left	3.5 × 2 × 1	Surgical resection	7
34, F	Kidney stones, neck mass	11.04	1410	4,347,000	MIBI suspect and US positive	Lower left	5 × 4.5 × 4*	Surgical resection after initial fine-needle aspiration with recurrence 1 month later	17

CT computed tomography, MIBI ^99mTc sestamibi, n.d. not determined, US ultrasound. * after preoperative fine-needle aspiration. Normal range for serum calcium is 8.6 to 10.2 mg/dl (to change units in mmol/l, divide by 4); parathyroid hormone is 10 to 70 pg/ml