J Korean Endocr Soc.  2007 Oct;22(5):353-358. 10.3803/jkes.2007.22.5.353.

A Case of Parathyroid Adenoma Manifested as Acute Pancreatitis Accompanied Subclinical Cushing's Syndrome due to an Adrenal Adenoma

• Leigh SH
• Jo DS
• Kim SW
• Jo YJ
• Cha SC
• Kim JK
• Park SH
• Kang HJ

• KMID: 1523105
• DOI: http://doi.org/10.3803/jkes.2007.22.5.353

Abstract

The manifestation of primary hyperparathyroidism by acute pancreatitis is a rare event. Furthermore, an asymptomatic adrenal mass may incidentally be detected by abdominal computed tomography. A mass that autonomously secretes glucocorticoid without any symptom is called subclinical Cushing's syndrome. In this study, we report a rare case of a parathyroid adenoma manifested as acute pancreatitis accompanied with subclinical Cushing's syndrome due to an incidental adrenal mass. A 47-year-old female patient presented with acute pancreatitis and hypercalcemia had a parathyroid mass detected by neck ultrasonography and a Tc(99m)-sestamibi scan. An abdominal computed tomography revealed a 3.1 x 4.3 cm mass which was detected in the left adrenal gland. The hormonal levels showed a high serum cortisol level, low ACTH level, and a high 24 h urine free cortisol level. The low and high dose dexamethasone suppression test showed no suppression. The parathyroid and adrenal masses were resected and the laboratory findings were normalized.

Keyword

Acute pancreatitis; Parathyroid adenoma; Subclinical Cushing's syndrome

MeSH Terms

Adenoma*
Adrenal Glands
Adrenocorticotropic Hormone
Cushing Syndrome*
Dexamethasone
Female
Humans
Hydrocortisone
Hypercalcemia
Hyperparathyroidism, Primary
Middle Aged
Neck
Pancreatitis*
Parathyroid Neoplasms*
Ultrasonography
Adrenocorticotropic Hormone
Dexamethasone
Hydrocortisone

Figure

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  Figure 1 Tc99m-sestamibi scan shows increased uptake in the right parathyroid region.

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  Figure 2 Abdomen CT demonstrates edematous pancreas with peripancreatic fluid collection.

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  Figure 3 Abdomen CT scan demonstrates left adrenal mass which is about 3.1 × 4.3 cm sized, well-marginated & homogeneous soft-tissue mass.

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  Figure 4 Abdominal CT scan demonstrates about 3.2 cm sized, well-marginated & round soft-tissue mass in left side of cul-de-sac, normal uterus & ovaries.

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  Figure 5 (A) Gross appearance of the parathyroid adenoma. (B) Microscopic finding of the parathyroid adenoma. Parathyroid adenoma is composed of solid sheet-like, acinar, follicle-like arrangement of parathyroid chief cells. There are normal parathyroidal glands within the fibrous capsular stroma (H & E stain, ×100).

• 

  Figure 6 (A) Gross appearance of the adrenal mass. (B) Microscopic finding of the adrenal adenoma. Adrenal adenoma reveals solid nests or cords of cells with pale abundant cytoplasm (H & E stain, ×40).

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