An unusual cause of hypercalcemic crisis: Water-clear cell double parathyroid adenoma (original) (raw)

2017, Turkish Journal of Surgery

INTRODUCTION Primary hyperparathyroidism is one of the most encountered endocrine pathologies, with an incidence of 21.6/100,000. In the etiology, the leading cause is solitary adenoma (87%-91%), generally originating from chief cells (1). Adenoma originating from more than one gland is a rarer event and comprises 2%-15% of all adenomas (2). The rare form (1%) of water-clear cell hyperplasia (WCCH) of hyperparathyroidism was first described by Albright et al. (3) in 1934. As adenoma in the etiology is even more uncommon, only 19 cases have been reported since 1994, and of those cases, adenoma was in both parathyroid glands in only one case (1, 2, 4-20). Hypercalcemic crisis, which was first described by Hannas in 1939, is a severe and life-threatening condition of severe hypercalcemia progressing to associated failure of various systems (21). Of the known cases, the case reported here is the first of hypercalcemic crisis caused by water-cell clear adenoma (WCCA). In previous reports related to WCCA, the histopathological features of the disease have generally been the focus. The aim of this study was to present the preoperative and postoperative periods of the disease and to evaluate the clinical characteristics. Defining the clinical characteristics of these kinds of rare cases can be considered useful for clinicians. In this case report, we present a patient who was successfully treated for double WCCA, and the case is discussed in comparison with the 19 cases reported in literature. MATERIAL AND METHODS A new case of WCCA with hyperparathyroidism is presented in this study and it was aimed to evaluate the preoperative clinical features and postoperative follow-up period in a comparison with other reports in literature of patients operated on for WCCA. Therefore, between January 2016 and March 2016, two of the authors scanned the PubMed and Google Scholar databases for publications between January 1, 1990 and March 21 2016 using the key words (Parathyroid tissue* OR Parathyroid gland* OR Parathyroid cells*) AND (Parathyroid adenoma* OR Adenoma*) AND (Water-clear-cell* OR water clear cell*) (Field: All Fields) (Figure 1). A total of 17 publications were determined, containing 19 patients with the demographic and technical data such as year of publication, patient age, gender, radiological and operative findings, and