Parathyroid gland hyperplasia associated with tuberculous granulomatous inflammation manifesting as primary hyperparathyroidism - 07/11/20
, F.J. Lage-Fernández a, L. López-Solache c, P. Parente-Arias aBienvenue sur EM-consulte, la référence des professionnels de santé.
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Highlights |
• | Inflammatory disorders of the parathyroid gland are poorly defined, and theories have always focused on diagnostic possibilities of probable autoimmune and non-infectious etiology. |
• | Tuberculosis continues to be a major public health problem, including in developing and developed countries with high incidence of the disease. |
• | Mycobacterial infection with chronic granulomatous inflammation could lead to mediators acting as paracrine regulators in germinal centers of the parathyroid chief cell mass, producing hyperplasia and increased glandular function. |
Abstract |
Objectives |
Inflammatory disorders of the parathyroid gland are poorly defined. Only seven cases of granulomatous infection have been reported in the literature.
Patients and methods |
A 68-year-old woman presented with parathyroid hormone level at 277pg/mL and calcium level at 10.8mg/dL, considered as primary hyperparathyroidism. Parathyroidectomy was performed, normalizing analytical values.
Results |
Normal-size gland with chief cell hyperplasia, focal pseudofollicular changes, and presence of epithelioid granulomas with Langhans giant cells and caseous necrosis areas, and a positive PCR for M. tuberculosis complex was identified. Chronic granulomatous inflammation could provoke a cascade of immune system activation, resulting in hyperplasia with the consequent increase in parathyroid function, and therefore primary hyperparathyroidism.
Conclusions |
In populations with a high incidence of tuberculosis, the coexistence of these pathologies must be kept in mind. This theory needs further biomolecular studies to be confirmed, but it provides a new perspective within the possible etiologies of hyperparathyroidism.
Le texte complet de cet article est disponible en PDF.Keywords : Hyperparathyroidism, Tuberculosis, Granulomatosis
Plan
Vol 50 - N° 8
P. 738-741 - novembre 2020 Retour au numéro
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