Int J Cur Bio Med Sci. 2011; 1(2): 47 - 48.
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International Journal of Current Biological and Medical Science
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Short Report
About a rare cause of primary hyperparathyroidism
M. Mlika a, Y. Zidi-Moaffak a , Y. Lakhoua b , F. Farah a , N. Kourda a , N. Ben Abdallah b, R. Zermani a ,
S. Baltagi-Ben Jilani a
a Department of pathology. Charles Nicolle Hospital. Tunis. Tunisia
bDepartment of endocrinology. Charles Nicolle Hospital. Tunis. Tunisia
ARTICLE INFO
ABSTRACT
Keywords:
Clear cell hyperplasia
Hyperparathyroidism
Management
Introduction: Primary hyperparathyroidism is observed in 35 to 44 subjects/ 100000 persons.
The increased production of parathyroid hormones is secondary to primary glandular
modifications consisting mainly in adenomas. The authors report a clear-cell hyperplasia
causing primary hyperparathyroidism. Observation: We report the case of a 25-year-old man
who was admitted to explore pathologic fractures of the left arm and a malignant
hypercalcaemia. Complementary laboratory tests revealed primary hyperparathyroidism. A
multiple endocrine neoplasia was excluded by radiologic examinations. Cervical ultra-sound
examination revealed 2 parathyroid adenomas and per-operative exploration showed 3 «
adenomas ». Microscopic examination of the 4 parathyroid glands specimen concluded to a
clear cell hyperplasia. Conclusion: Clear cell hyperplasia is a benign cause of primary
hyperparathyroidism. The diagnosis is based upon histologic findings and examination of the 4
glands.
© Copyright 2011. CurrentSciDirect Publications. IJCBMS - All rights reserved.
1. Introduction
Primary hyperparathyroidism is observed in approximately 35
to 44 persons/ 100000 subjects [1]. It occurs in the absence of a
renal affection or an intestinal malabsorption. The over-
production of parathyroid hormone is secondary to a parathyroid
adenoma in 75 to 80 % cases, parathyroid hyperplasia in 12 to 18
% cases and parathyroid carcinoma in less than 5 % of the cases
[2]. The authors describe a new case of clear cell hyperplasia
diagnosed in a case of primary hyperparathyroidism.
1.Observation
A 25-year-old patient was explored for a pathologic fracture of
the left arm and a malignant hypercalcaemia (4 mmol/l). He
presented, many times ago, multiple fractures of the same arm and
calcic renal lithiasis. Hormonal tests revealed a primary
hyperparathryoidism with a parathyroid hormone level reaching
1339 mmol/l, a malignant hyparcalcaemia reaching 4 mmol/l (N :
2,25- 2,62 mmol/l), a hypophosphoremia of 0,46 mmol/l (N : 0,8 -
1,45 mmol/l). An eventual multiple endocrinopathy was ruled out
* Corresponding Author : Dr Mona Mlika
Charles Nicolle Hospital, boulevard 9 avril 1938. 1006, Tunis.
TUNISIA. Ph: 0021698538862
Email: [email protected]
© Copyright 2011. CurrentSciDirect Publications. IJCBMS - All rights reserved.
thanks to many explorations. Cervical ultra-sound examination
showed double adenomas, the first was median and the second
was located in the left inferior parathyroid gland. Per-operatory
examination showed 3 adenomas. The first was isthmic, the
second was located in the left inferior parathyroid gland and the
third was situated in the posterior face of the left thyroid lobe.
Grossly, we received 3 glands measuring 1cm, 2,5 cm and 3 cm.
Microscopic eaxamination revealed, in the three glands, a
proliferation of monotonous clear cells organized in trabeculae
and masses (Figure 1a). At a higher power, intra-cytoplasmic clear
vacuoles were noted (Figure 1b). A normal parathyroid
parenchyma wasn't observed in these glands. Post operatory, the
calcaemia level decreased and the parathyroid hormone level
remained elevated. A post operatory scintigraphy showed the
persistence of an ectopic left latero-oesophageal parathyroid
gland. The patient was reoperaterd. Microcopic analysis of the
ectopic gland showed the same features as those of the remaining
glands. The diagnosis of clear cell parathryoid hyperpalsia was
retained.