Parathyroid adenoma

No excess of cancer was reported in two follow-up smdies of affected individuals in Turkey about 20-30 years after consumption of contaminated grain had ceased. " In mice, liver tumors were observed after exposure to HCB at 12-24mg/kg/day in the diet, but not at 6mg/kg/day. Hepatomas, hepatocellular carcinomas, bile duct adenomas, and renal cell adenomas were observed in rats after dietary administration." Liver tumors were also observed in 100% of surviving females and 16% of males after dietary administration to rats for 90 weeks. In another study, increased incidence of parathyroid adenomas and adrenal pheochromocytomas were observed in male and female rats and liver neoplastic nodules in females of the Ei generation in a two-generation feeding study. 

A 72-year-old woman received calcitonin 100 IU twice a week intramuscularly, calcitriol 0.25 micrograms bd, and daily calcium supplements for 3 years, before presenting with a raised calcium concentration (2.7 mmol/ 1) and linear calcification in the knee joints. The parathormone concentration was raised (151 pg/ml reference range 7-53) and a parathyroid adenoma was demonstrated on ultrasound (15). 

Ten patients who had taken lithium for less than 1 year and 13 who had taken it for more than 3 years were assessed for alterations in bone metabolism and parathyroid function (654). There were no differences in bone mineral density, serum calcium concentration, or PTH concentration, but both groups had increased bone turnover and the longterm group had nonsignificantly higher calcium and PTH concentrations (including one hyperparathyroid patient who had an adenoma excised). The authors conclusion that lithium therapy is not a risk factor for osteoporosis needs to be tempered by the small sample size, the case of adenoma, and the blood concentration trends. 

A 64-year-old woman who had taken lithium for over 10 years was admitted with altered consciousness, agitation, and disorientation. The serum calcium was 3.35 mmol/1 (reference range 2.1-2.6 mmol/1) and the PTH concentration was raised. With hydration and conversion from lithium to valproate, the serum calcium concentration normalized, but 2 years later disorientation and hypercalcemia recurred and a 150 mg parathyroid adenoma was removed surgically (665). 

A 51-year-old man who had taken lithium for over 10 years presented with nausea, vomiting, anorexia, hypercalcemia (3.1 mmol/1), and increased PTH concentration (iPTH 110 ng/1). Abnormalities resolved after an oxyphilic parathyroid adenoma was excised (667). 

A woman who had taken lithium for 15 years who became hypercalcemic and stopped taking lithium, but 2 years later had two parathyroid adenomas removed surgically (670). 

A 42-year-old man who had taken lithium for 17 years and who had raised serum calcium and PTH concentrations which normalized after removal of a parathyroid adenoma (671). 

Awad SS, Miskulin J, Thompson N. Parathyroid adenomas versus four-gland hyperplasia as the cause of primary hyperparathyroidism in patients with prolonged lithium therapy World J Surg 2003 27 486-8. 

Morillas Arino C, Jordan Lluch M, Sola Izquierdo E, Serra Cerda M, Garzon Pastor S, Gomez Balaguer M, Hernandez Mijares YA. [Parathyroid adenoma and lithium therapy.JEndocrinol Nutr 2002 49 56-7. 

Burski, K, Torjussen, B, Paulsen, AQ, Boman, H and Bollerslev, J, 2002, Parathyroid adenoma in a subject with familial hypocalciuric hypercalcemia coincidence or causality , J Clin Endocrinol Metab 87 1015-1016... 

In the studies of long-term exposure of rats to both triphenyltin hydroxide and bis(tributyltin)oxide, most of the tumors were found in endocrine glands. In addition to the pituitary adenomas associated with bis(tributyltin)oxide and triphenyltin hydroxide, there was also an increased incidence of pheochromocytomas of the adrenal gland, parathyroid carcinomas and pancreatic adenocarcinomas in animals from at least one sex. Triphenyltin hydroxide was associated with an increased incidence of testicular Leydig cell tumors in male rats at the highest dose. Hepatic tumors were found in male and female mice following 80 weeks of triphenyltin hydroxide administration. 

One female and one male patient had hyperparathyroidism with elevated serum alkaline phosphatase activities and extensive bone changes characteristic of generalized osteitis fibrosa cystica. In both instances, the serum acid phosphatase activity of the serum fell to normal values after removal of the parathyroid adenoma despite transitorily increased serum alkaline phosphatase activity. The fifth patient was a female with osteopetrosis involving the major part of the skeleton. The serum acid phosphatase was 8.7 K.A. units, the highest in the control series— yet the serum alkaline phosphatase was within normal limits. It would appear, therefore, that some patients with skeletal disease may have a slight but definitely elevated serum acid phosphatase activity, at least as determined by the Gutman method (GIO, G14), which cannot be explained by concurrent prostatic carcinoma or by a spillover of alkaline phosphatase activity to a pH of 5.0. 

Triggs SM, WiUiams ED. Irradiation of the thyroid as a canse of parathyroid adenoma. Lancet 1977 1(8011) 593. ... 

Most cases of lithium-induced hyperparathyroidism are mild [43]. Both pre-existing parathyroid abnormalities which may have been unmasked by lithium therapy and de novo hypercalcemia and hyperparathyroidism have been documented [44]. Parathyroid hyperplasia [33%] and adenomas [67%] were reported in one series of hypercalcemic patients treated with lithium [45]. Bilateral neck exploration has been proposed as an appropriate management approach because of a relatively high frequency of multi-gland involvement. However, parathyroid resection should be limited to those with overt disease [46]. 

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