Journal List > J Korean Endocr Soc > v.22(5) > 1003388

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Leigh, Jo, Kim, Jo, Cha, Kim, Park, and Kang: A Case of Parathyroid Adenoma Manifested as Acute Pancreatitis Accompanied Subclinical Cushing's Syndrome due to an Adrenal Adenoma
Case Report
Journal of Korean Endocrine Society

Journal of Korean Endocrine Society 2007; 22(5): 353-358.

Published online: 20 October 2007

DOI: https://doi.org/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

Sang Hoon Leigh, Dong Sik Jo, Si Woo Kim, Yu Jin Jo, Sung Chul Cha, Jung Kwon Kim, Sun Hee Park, Hang Ji Kang1

Department of Internal Medicine, Seoul Adventist Hospital, Korea.

1Department of Anatomical Pathology, Seoul Adventist Hospital, Korea.

Received 23 March 2007       Accepted 25 June 2007

Copyright © 2007 Korean Endocrine Society

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 Tc99m-sestamibi scan. An abdominal computed tomography revealed a 3.1 × 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.

Keywords: Acute pancreatitis, Parathyroid adenoma, Subclinical Cushing's syndrome

Figures and Tables

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).
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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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