Sialadenosis — ORE Part 1 MCQ

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ModerateOral MedicineSialadenosisORE Part 1

A 35-year-old man presents with bilateral painless enlargement of the parotid glands. He drinks 40 units of alcohol per week. Blood tests show elevated gamma-glutamyl transferase (GGT) and mean corpuscular volume (MCV). What is the most likely cause of the parotid enlargement?

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Correct answer: B — Alcohol-related sialadenosis

The diagnosis is alcohol-related sialadenosis. The clinical triad of bilateral painless parotid enlargement, heavy alcohol consumption (40 units/week), and elevated GGT with macrocytosis (elevated MCV) is pathognomonic. Sialadenosis is a non-inflammatory, non-neoplastic, symmetric, painless, persistent enlargement of the salivary glands (usually parotid), and alcoholism is one of the three primary causes alongside diabetes and malnutrition. The elevated GGT indicates hepatic involvement from chronic alcohol use, and elevated MCV reflects macrocytic anaemia/alcohol-related effects on red cells. Sjögren syndrome presents with painful swelling, sicca symptoms and positive autoimmune serology. Bilateral tumours and sarcoidosis are rare; mumps is acute and typically painful. The painless, bilateral, and persistent presentation in a heavy drinker with biochemical evidence of chronic alcohol abuse and hepatic dysfunction makes A the clear answer.

Reference: Gorlin RJ, Goldman HM (eds). 'Thoma's Oral Pathology', 6th edn. St. Louis: Mosby, 1997. Chapter on Sialadenosis; also 'Alcoholic parotid sialadenosis', PubMed 9332142 (1997). https://pubmed.ncbi.nlm.nih.gov/9332142/