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Table of Contents
Year : 2018  |  Volume : 22  |  Issue : 1  |  Page : 174-176

Parathyroid Lipoadenoma: A Rare Entity

1 Department of Endocrinology, Fortis Hospital, Shalimar Bagh, New Delhi, India
2 Department of Endocrine Surgery, Fortis Hospital, Shalimar Bagh, New Delhi, India

Date of Web Publication8-Feb-2018

Correspondence Address:
Ajay Aggarwal
Department of Endocrinology, Fortis Hospital, Shalimar Bagh, New Delhi - 110 088
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijem.IJEM_273_17

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How to cite this article:
Aggarwal A, Wadhwa R, Aggarwal V. Parathyroid Lipoadenoma: A Rare Entity. Indian J Endocr Metab 2018;22:174-6

How to cite this URL:
Aggarwal A, Wadhwa R, Aggarwal V. Parathyroid Lipoadenoma: A Rare Entity. Indian J Endocr Metab [serial online] 2018 [cited 2021 Sep 18];22:174-6. Available from: https://www.ijem.in/text.asp?2018/22/1/174/224996


Parathyroid lipoadenoma is an unusual variant of primary hyperparathyroidism (PHPT). It consists of hyperfunctioning parathyroid cell nests in abundant fatty stroma. Otherwise fat-containing lesions of endocrine glands are uncommon. It resembles lipoma rather than adenoma. Chow et al.[1] defined it as single parathyroid adenoma with more than 50% fat on histologic examination in conjunction with PHPT and resolution of hypercalcemia postoperatively. The World Health Organization defines parathyroid lipoadenoma as a “hamartoma-like benign neoplasm containing both chief cells and prominent stromal elements.”[2] Nonfunctional parathyroid lipoadenomas have also been reported.[3] Normally, fat occupies approximately 25% of adult parathyroid gland, and it increases with age and obesity.[4]

In 1958, Ober and Kaiser [5] described parathyroid lipoadenoma for the first time in an asymptomatic 43-year-old male and termed it as “hamartoma of the parathyroid.” It has also been reported as parathyroid lipohyperplasia [6] and parathyroid adenoma with myxoid stroma.[7] The term “parathyroid lipoadenoma” was coined in 1962 by Abul-Haj et al.[8] Parathyroid lipoadenomas can occur at any age group but are more common among middle-aged females.[6],[9] Clinical features and laboratory investigations of parathyroid lipoadenoma resemble that of usual parathyroid adenoma. Approximately 60 cases of parathyroid lipoadenoma have been reported so far. The rarity of the entity and resemblance with normal parathyroid tissue microscopically makes its diagnosis difficult. We present a case of a 34-year-old asymptomatic female found to have PHPT due to parathyroid lipoadenoma.

A 34-year-old female diagnosed to have mild hypercalcemia (10.9 mg/dl) and hypophosphatemia (1.9 mg/dl) on routine investigations was referred to us for further evaluation. She did not have any symptoms suggestive of PHPT such as bone pains, fatigue, kidney stones, fractures, and proximal muscle weakness. On examination, a large, soft mass was palpable on lower part of the right side of neck extending behind manubrium. The systemic examination was unremarkable. Laboratory investigation showed high PTH (638.2 pg/ml), low Vitamin D levels (12 ng/ml), and high 24-h urinary calcium (516.4 mg/dl) with normal renal and liver function tests.99 Tc-sestamibi scan did not show any area of high uptake in the neck. Ultrasound and computed tomography scan neck showed soft-tissue mass lesion on the right lower neck extending into mediastinum [Figure 1]a. On parathyroid exploration, enlarged right inferior parathyroid gland embedded in a large fatty mass, extending behind carotid artery and jugular vein into mediastinum, was revealed. Right inferior parathyroidectomy with the removal of mediastinal component of the mass was done; it was easily dissectible from the surrounding structures.
Figure 1: Radiological (a) gross, (b) low-power microscopic, (c) view of parathyroid lipoadenoma. Computed tomography: Mass lesion on the right lower neck extending into mediastinum

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The specimen consisted of yellow, lobulated, soft-tissue mass, 8 cm × 4 cm × 4 cm in size, weighing 34 gm. Cut sections showed predominantly yellow areas with focal nodular gray-white areas [Figure 1]b. Microscopic examination showed nodules and islands of parathyroid epithelial cells in a background of abundant lipomatous tissue [Figure 1]c. It was encapsulated all over. The parathyroid epithelial cells were predominantly chief cells type. No atypia, mitosis, necrosis, and capsular or vascular invasion were seen. Based on these gross and microscopic findings, diagnosis of parathyroid lipoadenoma was made.

Postoperatively, PTH and serum calcium levels dropped to 187 pg/ml and 8.4 mg/dl, respectively. The patient was discharged on oral calcium and Vitamin D supplementations. The patient was normocalcemic at last observation before writing of this case.

Single parathyroid adenoma (85%) is most common cause of PHPT. Parathyroid lipoadenoma is its rare and unusual variant. Obara et al.[10] reported 4 (1.6%) cases of parathyroid lipoadenoma in a series of 253 cases of PHPT. Parathyroid lipoadenomas vary in weight and may measure up to several centimeters. Because of the large size, they may extend into the mediastinum. Parathyroid lipoadenoma consists of intermingling of chief and oxyphil cells with abundant adipose cells, which comprises 20%–90% of tumor.[11],[12] It can have either chief cell or oxyphil cells as functional component.[1] Origin of enlargement of fatty tissue component remains unknown; maybe factors responsible for parathyroid chief cell enlargement also cause it.

In previously reported cases, approximately 64% cases had symptomatic disease, 28% were asymptomatic, and 7% had questionable symptoms.[13] Unlike parathyroid adenomas, they are not associated with multiple endocrine neoplasias or familial hyperparathyroidism. Parathyroid lipoadenoma is difficult to detect on preoperative imaging, may be due to high-fat content. Nuclear scan in our patient was not able to detect any lesion. The comparative differences between parathyroid lipoadenoma and classic parathyroid adenoma are mentioned in [Table 1].
Table 1: Differences between parathyroid lipoadenoma and classic parathyroid adenoma

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We conclude that due to rarity of the entity, parathyroid lipoadenoma as a cause of PHPT may be overlooked. Hence, knowledge of this entity is necessary to ensure that it does not get unnoticed as a cause of PHPT.


We would like to thank Dr. Vijay Katekhaye (Quest MedPharma Consultants, Nagpur) for his assistance in editing this letter. Patient consent was taken for publishing the case. For the same, patient provided with investigation details to us and we thank her for the consent.

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Conflicts of interest

There are no conflicts of interest.

   References Top

Chow LS, Erickson LA, Abu-Lebdeh HS, Wermers RA. Parathyroid lipoadenomas: A rare cause of primary hyperparathyroidism. Endocr Pract 2006;12:131-6.  Back to cited text no. 1
Solcia E, Kloppel G, Sobin LH. Histological Typing of Endocrine Tumors. 2nd ed. Berlin, Germany: Springer-Verlag; 2000. p. 48-50.  Back to cited text no. 2
Udén P, Berglund J, Zederfeldt B, Aspelin P, Ljungberg O. Parathyroid lipoadenoma: A rare cause of primary hyperparathyroidism. Case report. Acta Chir Scand 1987;153:635-9.  Back to cited text no. 3
Castlemann B, Roth SJ. Tumors of the parathyroid glands. In: Atlas of Tumor Pathology. Fascicle 14. Washington, D.C.: Armed Forces Institute of Pathology; 1978. p. 3-19.  Back to cited text no. 4
Ober WB, Kaiser GA. Hamartoma of the parathyroid. Cancer 1958;11:601-6.  Back to cited text no. 5
Straus FH 2nd, Kaplan EL, Nishiyama RH, Bigos ST. Five cases of parathyroid lipohyperplasia. Surgery 1983;94:901-5.  Back to cited text no. 6
Fischer I, Wieczorek R, Sidhu GS, Pei Z, West B, Lee P, et al. Myxoid lipoadenoma of parathyroid gland: A case report and literature review. Ann Diagn Pathol 2006;10:294-6.  Back to cited text no. 7
Abul-Haj SK, Conklin H, Hewitt WC. Functioning lipoadenoma of the parathyroid gland. Report of a unique case. N Engl J Med 1962;266:121-3.  Back to cited text no. 8
Seethala RR, Ogilvie JB, Carty SE, Barnes EL, Yim JH. Parathyroid lipoadenomas and lipohyperplasias: Clinicopathologic correlations. Am J Surg Pathol 2008;32:1854-67.  Back to cited text no. 9
Obara T, Fujimoto Y, Ito Y, Kodama T, Kanaji Y, Okamoto T, et al. Functioning parathyroid lipoadenoma – Report of four cases: Clinicopathological and ultrasonographic features. Endocrinol Jpn 1989;36:135-45.  Back to cited text no. 10
Rastogi A, Jain M, Agarawal T, Mishra AK, Gupta S, Agarwal A, et al. Parathyroid lipoadenoma: Case report and review of the literature. Indian J Pathol Microbiol 2006;49:404-6.  Back to cited text no. 11
Bansal R, Trivedi P, Sarin J, Parikh B. Lipoadenoma of the parathyroid gland – A rare cause of hyperparathyroidism. Gulf J Oncolog 2012;11:63-5.  Back to cited text no. 12
Turner WJ, Baergen RN, Pellitteri PK, Orloff LA. Parathyroid lipoadenoma: Case report and review of the literature. Otolaryngol Head Neck Surg 1996;114:313-6.  Back to cited text no. 13


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