title: Sarcoid granulomas in the parathyroid gland - a case of dual pathology: hypercalcaemia due to a parathyroid adenoma and coexistent sarcoidosis with granulomas located within the parathyroid adenoma and thyroid gland.
abstract: We present a highly unusual and interesting case of coexistent hyperparathyroidism and sarcoidosis leading to hypercalcaemia. A 70 year old female presented with weight loss, constipation and dehydration. Investigations revealed marked hypercalcaemia with a non-suppressed PTH. In view of the degree of hypercalcaemia as well as the unintentional weight loss, investigations for malignancy were conducted -these were negative. Parathyroid imaging was then requested and an adenoma was identified. Surprisingly, surgery revealed the coexistence of a parathyroid adenoma with the unexpected finding of sarcoid granulomas within the parathyroid and thyroid glands. To our knowledge, this is the first such case reported. Further imaging confirmed pulmonary sarcoidosis and a serum ACE was elevated. Serum calcium levels did not respond to parathyroidectomy but eventually fell with steroid therapy.
authors.affiliation: Department of Endocrinology, Respiratory, ENT, Pathology and Radiology, Lister Hospital, Stevenage, Hertfordshire, UK. ABala75@hotmail.com
authors.forename: Anjali
authors.initials: A
authors.lastname: Balasanthiran
authors.forename: Belinda
authors.initials: B
authors.lastname: Sandler
authors.forename: Kwamena
authors.initials: K
authors.lastname: Amonoo-Kuofi
authors.forename: Rajiv
authors.initials: R
authors.lastname: Swamy
authors.forename: Sunil
authors.initials: S
authors.lastname: Kaniyur
authors.forename: Felicity
authors.initials: F
authors.lastname: Kaplan
mesh_terms: D000236:Adenoma / Q000150:complications* / Q000601:surgery; D000368:Aged; D005260:Female; D006099:Granuloma / Q000150:complications* / Q000601:surgery; D006801:Humans; D006934:Hypercalcemia / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D009378:Neoplasms, Multiple Primary / Q000150:complications / Q000601:surgery; D010279:Parathyroid Diseases / Q000150:complications* / Q000601:surgery; D010280:Parathyroid Glands / Q000473:pathology / Q000601:surgery; D010282:Parathyroid Neoplasms / Q000150:complications* / Q000601:surgery; D016105:Parathyroidectomy; D012507:Sarcoidosis / Q000150:complications* / Q000601:surgery; D013961:Thyroid Gland / Q000473:pathology; D013964:Thyroid Neoplasms / Q000150:complications*