An Interesting Case of Life-Threatening Hypercalcemia Secondary to Atypical Parathyroid Adenoma versus Parathyroid Carcinoma (original) (raw)
Related papers
Journal of Medical Cases, 2013
Atypical parathyroid adenoma is among the tumors diagnosed difficultly and including some histological features of parathyroid carcinoma. In literature, no definite criteria have been considered to be present to distinguish atypical parathyroid adenoma preoperatively from parathyroid carcinoma. A 65-year-old woman was admitted to our clinic with complaints of arthralgia, myalgia, fatigue and loss of appetite. She had severe hypercalcemia (serum calcium 17.2 mg/dL) and hypophosphatemia (serum phosphate 1.9 mg/dL) along with an elevated intact parathyroid hormone level of 879 pg/mL. Renal functions were within normal limits. The patient was administered with intravenous hydration and diuretic treatments because of severe hypercalcemia. Six sessions of hemodialysis were performed. In neck ultrasonography, multinodular goitre was detected. Tc-99m sestamibi scintigraphy revealed a focal involvement at the middle-inferior region of left thyroid lobe. Neck magnetic resonance imagination revealed a nodular lesion in size of 22 × 14 mm at the posterior region of left thyroid lobe. Parathyroidectomy guided by intraoperative gamma probe was performed. The lesion was histopathologically consistent with atypical parathyroid adenoma. In the postoperative period, serum calcium and intact parathyroid hormone levels were decreased as levels of 7 mg/dL and 42.6 pg/mL, respectively. We reported an atypical parathyroid adenoma accompanied by severe hypercalcemia and hyperparathyroidism.
Hypercalcemic Crisis in A Patient with A Huge Mediastinal Atypical Parathyroid Adenoma
AACE Clinical Case Reports, 2018
Objective: To describe a patient who presented with hypercalcemic crisis and severe hyperparathyroidism who had urgent surgery. She was found to have a huge mediastinal atypical parathyroid adenoma (APA). We discuss our case, the difficulty discriminating an APA from parathyroid cancer, and the tools that help differentiate these conditions. Methods: We present the clinical manifestations, laboratory results, radiologic and surgical findings, and management in a patient with hyperparathyroid crisis. Discussion follows. Results: We report a case of a 39-year-old woman who presented with symptoms of severe hypercalcemia. Her intact parathyroid hormone level was found to be markedly elevated, consistent with primary hyperparathyroidism. Imaging revealed an anterior mediastinal mass, suggestive of possible ectopic parathyroid tissue. Urgent surgery and subsequent pathologic study of the excised mass revealed a supernumerary 37.5-g parathyroid gland within the mediastinum surrounded by a rim of thymic tissue. Histologically, the adenoma did not meet the World Health Organization criteria for the diagnosis of parathyroid carcinoma; however, the adenoma had atypical pathologic features given an abnormal mitotic figure. Parafibromin staining was performed and largely negative in the center of the tumor. Germline analysis of the MEN1 and CDC73 genes revealed no pathogenic variants. Her postoperative course was complicated by hypocalcemia but took several days to develop. Conclusion: The distinction between APA and parathyroid carcinoma may be difficult, and parafibromin staining and genetic testing for CDC73 mutations should be considered, as the results have implications for patient follow-up as well as for patients' relatives. (AACE Clinical Case Rep. 2018;4:e224-e227
Asymptomatic Hypercalcemia Due to Bilateral Parathyroid Adenoma: A Case Report
https://www.ijrrjournal.com/IJRR\_Vol.9\_Issue.7\_July2022/IJRR-Abstract66.html, 2022
Hyperparathyroidism caused by parathyroid adenoma is one of causes of hypercalcemia. Majority of parathyroid adenoma cases are found incidentally. We report a male patient aged 40 years, asymptomatic, who is undergoing routine laboratory examinations to extend his work contract. On examination we found an increase in calcium levels and parathyroid hormone levels. Then MSCT examination showed bilateral parathyroid adenoma. The diagnosis pathway and proper treatment for parathyroid adenoma can be challenging and problematic owing to inability of standard imaging to detect small enlargement of parathyroid glands. MSCT has the advantage of being able to detect small parathyroid lesions that cannot be detected by simple imaging modalities. Parathyroidectomy is the definitive treatment for adenoma parathyroid.
The Annals of The Royal College of Surgeons of England, 2020
Introduction Hypercalcaemic crisis is a rare manifestation of hyperparathyroidism and occurs in 1.6–6% of patients with primary hyperparathyroidism (pHPT). Although such high serum calcium levels (>14mg/dl) are attributed to malignancy, it is also associated with benign disease of the parathyroid glands. The aim of this study was to evaluate the clinical features and treatment modalities of patients with severe hypercalcaemia who underwent surgery for pHPT. Methods The medical records of 537 patients who underwent parathyroidectomy in our department for pHPT between 2005 and 2019 were reviewed retrospectively. Twenty-four (4.4%) of the patients were described as having severe hypercalcaemia. Results Among 24 patients, 71% were female and the mean age was 55.7 years (range: 40–71 years). The mean serum calcium level at time of diagnosis was 15.9mg/dl (range: 14–22.7mg/dl). According to postoperative pathology reports, solitary adenoma, parathyroid cancer and parathyromatosis were ...
Hypercalcemia And Metastic Parathyroid Carcinoma: Diagnostic Challenge
Parathyroid carcinoma is an extremely rare neoplasm which typically is associated with hardened nodules in the parathyroid region, hypercalcemia and renal failure. A 69 year-old woman presented with knee pain at an emergency unity. On clinical examination the patient also presented a 2.0cm fibroelastic and mobile node in the left neck, level II. Serum total calcium and parathyroid hormone were increased, and the node was also detected by CT and 99mTc-sestamib scintigraphy. The patient had been surgically previously treated of parathyroid carcinoma misdiagnosed as a thyroid adenoma (eleven years ago), and a hyperplasia of parathyroid chief cells (nine years ago), that after revision was diagnosed as cervical metastasis of parathyroid carcinoma. She was surgically treated by neck dissection, confirming the second regional metastasis of parathyroid carcinoma. The diagnosis of parathyroid carcinoma is a challenge, and although rare, it should be considered in the presence of hypercalcemia and palpable neck nodule. Key Words: Parathyroid Carcinoma; Hypercalcemia; Hyperparathyroidism; Lymph Node Metastasis; Nodule
Parathyroid Adenoma Complicated with Severe Hypercalcemia, Encephalopathy and Pancreatitis
Turkish Journal of Endocrinology and Metabolism, 2015
Primary hyperparathyroidism is the most frequent cause of hypercalcemia in adults. Primary hyperparathyroidism generally leads to mildmoderate hypercalcemia. Severe hypercalcemia in these cases is rare. Coexistence of severe hypercalcemia and hypercalcemic encephalopathy is very unusual with very limited number of reported cases. Our case is a 50-year-old female who presented to the emergency department with the complaints of nausea and severe abdominal pain. Her serum calcium level was 19.7 mg/dL (8.8-10.2 mg/dL) and her PTH level was 73.5 ng/ dL (15-65) on presentation. After her hospitalization, she was treated with saline infusions and furosemide, however, her calcium level increased to 22.4 mg/dL. Her calcium levels were also refractory to subcutaneous calcitonin 200 mg twice a day and zoledronic acid 4 mg. Ultrasonography of the neck revealed a 3.2x2.7x4.6 cm mass suspicious for a left parathyroid adenoma hardly being distinguished from a left thyroid nodule. Considering her general situation getting worse despite maximum medical treatment, she underwent an emergency parathyroidectomy and total thyroidectomy. Early postoperatively, the patient's general condition deteriorated reaching a precoma state. Cranial computed tomography (CT) at this point revealed periventricular ischemia compatible with metabolic encephalopathy. During the follow-up postoperatively, the patient's serum calcium levels normalized eventually requiring active vitamin D and calcium pills and she no longer had symptoms of encephalopathy. The pathology specimen was reported as a parathyroid neoplasm compatible with atypical parathyroid adenoma. Although mild-moderate hypercalcemia is frequent in primary hyperparathyroidism, it should be noted that it can be severe and refractory to maximum medical treatment requiring emergency surgical intervention. In addition, not being one of the most frequent reasons, severe hypercalcemia due to primary hyperparathyroidism should be considered as an important cause of metabolic encephalopathy.
Functional evidence for two types of parathyroid adenoma
Clinical Endocrinology, 1998
OBJECTIVE The carboxyterminal parathyroid hormone (C-PTH)/intact (I-) PTH ratio is in¯uenced by serum calcium concentrations in man, increasing to a maximum value in hypercalcaemia and decreasing to a minimum value in hypocalcaemia. We decided to use this ratio to screen for parathyroid tumour with a normal sensitivity to calcium, symptomatic mainly through a mass effect. DESIGN AND SUBJECTS Nineteen patients with hypercalcaemia and elevated or inappropriate PTH, were studied in the basal state and during CaCl 2 and Na 2 EDTA infusion and compared with 26 normal individuals. They all had one parathyroid adenoma removed surgically, and two remained hypercalcaemic. RESULTS In the basal state, the patients were hypercalcaemic (ionized calcium 1´44 6 0´12 vs. 1´23 6 0´03 mmol/l, P < 0´001) and had elevated PTH levels (I-PTH: 10´8 6 8´0 vs. 2´3 6 0´6 pmol/l, P < 0´001; C-PTH: 31´6 6 38´9 vs. 5´25 6 1´11 pmol/l, P < 0´001) when compared with normals. Their mean C-PTH/I-PTH ratio was similar to normals (2´7 6 1´3 vs. 2´4 6 0´6, NS) but, when individual values were considered, three patients had elevated values at 4´9, 5´3 and 5´8 (normal 1´2±3´6). The regression line between basal C-and I-PTH revealed a signi®cantly higher slope in these patients (P < 0´0001). The 16 patients with a normal basal C-PTH/I-PTH ratio had, as a group, an increased set point of I-or C-PTH stimulation by calcium and increased values of stimulated and non-suppressible I-and C-PTH, but these abnormalities were not all present in the smaller tumours (#200 mg). Only three tumours in that group were larger than 1000 mg.
Parathyroid carcinoma and hungry bone syndrome
Arquivos Brasileiros de Endocrinologia & Metabologia, 2013
We hereby report two patients with parathyroid carcinoma presenting extremely high calcium and PTH levels, severe bone disease, and palpable neck mass at diagnosis. They both underwent parathyroidectomy, and one of them evolved to lung metastasis. Important hypocalcemia was observed after surgery in both: after parathyroidectomy in one patient, and only after surgical removal of the metastasis in the other. Both required intravenous calcium replacement, thus revealing hungry bone syndrome (HBS). HBS usually reflects rapid mineralization after correction of hyperparathyroidism. The more severe the bone disease before surgery, the more prone the patient is to HBS after surgery. Despite being an unfavorable outcome, HBS state suggests that surgical removal of hypersecretory parathyroid tissue was accomplished. In this study, HBS was observed in both patients, who presented severe bone disease prior to surgery. HBS would be expected post-operatively in successful parathyroid carcinoma r...