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©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
Twin pregnancy with triple parathyroid adenoma: A case report and review of literature
Yu Zhang, Jin-Wang Ding, Ling-Ying Yu, Ding-Cun Luo, Jian-Liang Sun, Zhi-Kai Lei, Zhi-Hua Wang
Yu Zhang, Jin-Wang Ding, Ding-Cun Luo, Department of Oncology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
Ling-Ying Yu, Department of Endocrinology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
Jian-Liang Sun, Department of Anesthesiology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
Zhi-Kai Lei, Department of Ultrasound Branch, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
Zhi-Hua Wang, Department of Obstetrics and Gynecology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
Author contributions: Luo DC was accountable for the execution of the case report and the integrity and analysis of the data; Ding JW, Lei ZK, Sun JL, Wang ZH and Yu LY collected patient’s clinical data; Zhang Y, Ding JW and Yu LY analyzed the data and wrote the paper; all authors read and approved the final manuscript.
Supported by the Key Project of Scientific and Technological Innovation in Hangzhou, NO. 20131813A08; the Key Project of Medical Scientific and Technology Program in Hangzhou, NO. 2013Z04; the Traditional Chinese Medical Science Research Program of Zhejiang Province, NO. 2018239534; the Applied Research Project of Commonweal Technology in Zhejiang Province, NO. 2017C33180.
Informed consent statement: Written informed consent was obtained from the patient for publication of this case report and accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
Open-Access: 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/
Correspondence to: Ding-Cun Luo, MD, Chief Doctor, Professor, Surgeon, Department of Oncology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, No. 261 Huansha Road, Hangzhou 310006, Zhejiang Province, China. ldc65@163.com
Telephone: +86-571-56006981 Fax: +86-571-87914773
Received: June 21, 2018
Peer-review started: June 21, 2018
First decision: July 8, 2018
Revised: July 20, 2018
Accepted: August 6, 2018
Article in press: August 6, 2018
Published online: October 6, 2018
ARTICLE HIGHLIGHTS
Case characteristics
The patient presented with nausea, vomiting and general malaise and elevated serum calcium.
Clinical diagnosis
Physical examination showed the patient’s spirit is soft, the lower abdomen is bulging.
Differential diagnosis
The differential diagnosis included multiple myeloma, secondary hyperpaathyroidism, familial hyperparathyroidism syndrome and multiple endocrine gland diseases. The disease can be differentiated from other diseases by asking history and combining laboratory, imaging tests.
Laboratory diagnosis
Blood test results were as follows: Parathyroid hormone (PTH) 187 pg/mL, serum calcium 3.49 mmol/L, serum phosphorus 0.62 mmol/L, alkaline phosphatase 76 mmol/L.
Imaging diagnosis
Ultrasound on the neck showed a moderately echogenic nodule (2.0 cm × 0.8 cm) on the dorsal side of the upper left thyroid gland, which parathyroid adenoma was the first consideration. Thyroid right lower lobe dorsal lateral process nodule (TI-RADS 3).
Pathological diagnosis
Postoperative pathology suggested that “three lesions are all parathyroid adenomas”.
Treatment
Treatment with parathyroid tumor resection the cervical plexus nerve block during mid-pregnancy.
Related reports
Primary hyperparathyroidism during pregnancy have been reported previously, they were all have a single parathyroid adenoma or choose to complete the radiological examination after termination of pregnancy. But we report a unique case of twin pregnancy with three parathyroid adenomas, without radiological examination, had good pregnancy outcomes after undergoing surgery during mid-pregnancy.
Term explanation
IPM: Intraoperative parathormone monitoring.
Experiences and lessons
Given the severity of the associated complications, every effort should be made to ensure prompt diagnosis and reasonable treatment. Do not rely on imaging diagnosis. Careful exploration, rapid detection of PTH after surgical resection and the removal of diseased glands to the ideal value, which called IPM is the key to successful operation.
