Chiang PH, Ko KH, Peng YJ, Huang TW, Tang SE. Hyperparathyroidism presented as multiple pulmonary nodules in hemodialysis patient status post parathyroidectomy: A case report. World J Radiol 2024; 16(9): 466-472 [PMID: 39355397 DOI: 10.4329/wjr.v16.i9.466]
Corresponding Author of This Article
Tsai-Wang Huang, MD, PhD, Attending Doctor, Chief Doctor, Surgeon, Division of Thoracic Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, No. 325 Section 2, Chenggong Road, Neihu District, Taipei 114202, Taiwan. chi-wang@yahoo.com.tw
Research Domain of This Article
Surgery
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Ping-Han Chiang, Department of Surgery, Tri-Service General Hospital, Taipei 114202, Taiwan
Kai-Hsiung Ko, Department of Radiology, National Defense Medical Center, Tri-Service General Hospital, Taipei 114, Taiwan
Yi-Jen Peng, Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
Tsai-Wang Huang, Division of Thoracic Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114202, Taiwan
Shih-En Tang, Division of Thoracic Medicine, Department of Internal Medicine, Tri-Service General Hospital, Taipei 114202, Taiwan
Author contributions: Chiang PH organized the patient information, generated the data and wrote the manuscript; Ko KH, Peng YJ, Huang TW, and Tang SE were the patient’s attending physicians and participated in clinical and intellectual discussions related to the article; all authors have read and approved the final manuscript.
Informed consent statement: Informed consent was obtained before the article was written.
Conflict-of-interest statement: All authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: Guidelines of the CARE Checklist (2016) have been adopted.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Tsai-Wang Huang, MD, PhD, Attending Doctor, Chief Doctor, Surgeon, Division of Thoracic Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, No. 325 Section 2, Chenggong Road, Neihu District, Taipei 114202, Taiwan. chi-wang@yahoo.com.tw
Received: June 15, 2024 Revised: August 7, 2024 Accepted: August 28, 2024 Published online: September 28, 2024 Processing time: 103 Days and 15.4 Hours
Abstract
BACKGROUND
Primary hyperparathyroidism is typically caused by a single parathyroid adenoma. Ectopic parathyroid adenomas occur as well, with cases involving various sites, including the mediastinum, presenting in varying frequencies. Secondary hyperparathyroidism develops in the context of chronic kidney disease, primarily due to vitamin D deficiency, hypocalcemia, and hyperphosphatemia. It is frequently diagnosed in patients undergoing dialysis. This article presents a rare case of hyperparathyroidism involving multiple hyperplastic parathyroid glands with pulmonary seeding in a 50-year-old female patient undergoing hemodialysis (HD).
CASE SUMMARY
The patient had a history of parathyroidectomy 10 years prior but developed recurrent hyperparathyroidism with symptoms of pruritus and cough with sputum during a period of routine dialysis. Radiographic imaging revealed multiple nodules in both lungs, with the largest measuring approximately 1.35 cm. Surgical histopathology confirmed the presence of hyperplastic parathyroid glands within the pulmonary tissue. After tumor resection surgery via video-assisted thoracic surgery with wedge resection, the patient was discharged in stable condition and in follow-up her symptoms showed improvement.
CONCLUSION
This article describes hyperparathyroidism presenting as pulmonary nodules in a patient undergoing post-parathyroidectomy HD, highlighting diagnostic challenges and a positive outcome from tumor resection surgery.
Core Tip: This case highlights a rare occurrence of hyperplastic parathyroid gland seeding in pulmonary tissue in a patient with end-stage renal disease and recurrent hyperparathyroidism. The study underscores the diagnostic challenge posed by atypical presentations of hyperparathyroidism in patients undergoing dialysis, emphasizing the crucial role of comprehensive imaging and histopathological examination. Surgical resection proved effective in alleviating symptoms, suggesting its therapeutic utility in managing such complex cases. Further research is needed to refine management strategies and improve outcomes for similar clinical scenarios.
