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Triple water clear cell parathyroid adenomas: a rare cause of primary hyperparathyroidism
  1. Constantinos Parpounas1,
  2. Theodoros Lyssiotis2 and
  3. Vasilis Constantinides1
  1. 1Endocrine Surgery, Evangelistria Medical Centre, Nicosia, Cyprus
  2. 2Dr Doros Lyssiotis Histopathology And Cytology Medical Centre, Nicosia, Cyprus
  1. Correspondence to Dr Vasilis Constantinides; vascons{at}


A man in his 70s was referred to the endocrine surgery department after incidental finding of hypercalcaemia during preoperative work-up for abdominal aortic aneurysm repair. The patient reported severe fatigue and malaise with no previous history of nephrolithiasis or osteoporosis. After biochemical confirmation of primary hyperparathyroidism, localisation studies suggested multiple gland disease. Intraoperatively, three enlarged parathyroid adenomas were found and excised. Histopathological and immunohistochemical examination revealed triple water clear cell (WCC) parathyroid adenomas. Adenomas being entirely composed of WCCs are rare. In addition, triple adenomas are so rare that their existence is disputed by some authors. The present paper reports on an extremely rare case of a patient suffering from triple parathyroid adenomas composed entirely of WCCs. To our knowledge, this is the first such reported case in the English language literature.

  • Calcium and bone
  • General surgery
  • Head and neck surgery
  • Vascular surgery
  • Cardiovascular medicine

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  • Contributors CP: manuscript preparation and submission. TL: histopathology section, preparation of histology images and manuscript review. VC: senior author responsible for patient surgery and care, data collection, manuscript revision and editing.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.