Unusual presentation in a case of primary hyperparathyroidism

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Abstract

This report describes a case of classic severe primary hyperparathyroidism (PH) with clinical presentation that is very infrequent nowadays, which was osteitis fibrosa cystica. As bone scintigraphy demonstrated multiple areas of increasing uptake associated with hypercalcemia, a thorough investigation was conducted to exclude the neoplasms which most frequently are responsible for bone secondarisms. A fludeoxyglucose (FDG) positron emission tomography/CT demonstrated diffuse and multiple foci of increased FDG uptake and a focal uptake at the left thyroid region. Parathyroid function was studied, revealing unexpectedly high parathyroid hormone (PTH) levels. Further tests confirmed the diagnosis of PH and localized a parathyroid adenoma in the lower left side.

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Presentation of asymptomatic primary hyperparathyroidism: proceedings of the third international workshop.

Shonni J. Silverberg, E. Lewiecki, Leif Mosekilde … (2009)

At the Third International Workshop on Asymptomatic Primary Hyperparathyroidism (PHPT) in May 2008, recent data on the disease were reviewed. We present the results of a literature review on issues arising from the clinical presentation and natural history of PHPT. Questions were developed by the International Task Force on PHPT. A comprehensive literature search for relevant studies was reviewed, and the questions of the International Task Force were addressed by the Consensus Panel. 1) Data on the extent and nature of cardiovascular involvement in those with mild disease are too limited to provide a complete picture. 2) Patients with mild PHPT have neuropsychological complaints. Although some symptoms may improve with surgery, available data remain inconsistent on their precise nature and reversibility. 3) Surgery leads to long-term gains in spine, hip, and radius bone mineral density (BMD). Because some patients have early disease progression and others lose BMD after 8-10 yr, regular monitoring (serum calcium and three-site BMD) is essential in those followed without surgery. Patients may present with normocalcemic PHPT (normal serum calcium with elevated PTH concentrations; no secondary cause for hyperparathyroidism). Data on the incidence and natural history of this phenotype are limited. 4) In the absence of kidney stones, data do not support the use of marked hypercalciuria (>10 mmol/d or 400 mg/d) as an indication for surgery for patients. 5) Patients with bone density T-score -2.5 or less at the lumbar spine, hip, or distal one third radius should have surgery.

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The changing presentation of hyperparathyroidism over 3 decades.

Mira Milas, Eren Berber, Melissa A. Kovach … (2008)

To analyze changes in the presentation of primary hyperparathyroidism over the last 3 decades. Retrospective review. Tertiary referral center. Three hundred patients undergoing parathyroidectomy for primary hyperparathyroidism, 100 each in the years 1985, 1995, and 2005. Analysis was performed based on patient age, sex, preoperative calcium value, duration of hypercalcemia, symptoms at presentation, and reason for surgical referral. Patients from the years 1985, 1995, and 2005 were similar in age and sex. Mean (SEM) preoperative calcium values decreased from 11.8 (0.1) mg/dL in 1985 to 11.2 (0.1) mg/dL in 2005 (P < .001) (to convert milligrams per deciliter to millimoles per liter, multiply by 0.25). The proportion of patients with preoperative calcium values less than 11.0 mg/dL steadily rose from 10% in 1985 to 43% in 2005 (P < .001). The mean (SEM) time from diagnosis of hypercalcemia until surgical referral decreased from 2.5 (0.4) years in 1985 to 1.6 (0.2) years in 2005 (P = .08). The primary reason for referral has shifted toward osteoporosis (20% in 2005 vs 7% in 1985; P = .03). The percentage of patients diagnosed with osteoporosis or osteopenia preoperatively increased from 10% in 1985 to 44% in 2005 (P < .001), and the recognition of these conditions in men increased from 3% to 26% (P = .10). Over the last 3 decades, increased awareness of hyperparathyroidism and its consequences as well as the institution of screening bone densitometry have changed the profile of patients who are referred for surgery. Patients are being referred sooner, with a lesser degree of hypercalcemia and greater recognition of osteoporosis.

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Multiple brown tumors in parathyroid carcinoma mimicking metastatic bone disease.

J. Park, Stella Y. Chung, Keerthilatha-M. Pai … (1997)

An unusual case of multiple brown tumors due to parathyroid carcinoma is reported. The patient presented with lower leg pain. Plain radiographs demonstrated multiple lytic lesions of the lower legs and a Tc-99m MDP bone scan depicted multiple areas of increased uptake suggesting skeletal metastases. Tc-99m sestamibi tumor scintigraphy showed multiple sites of tumor uptake in bones and a large area of increased uptake with a cystic component in the right lower pole of the thyroid gland. An open biopsy from the right tibial lesion revealed a brown tumor. A large parathyroid carcinoma with a necrotic cyst was removed. After parathyroidectomy and right thyroid lobectomy, the patient became free of bone pain and serum PTH levels normalized. A 9-month follow-up Tc-99m MDP bone scan demonstrated less intense uptake in the pelvis, tibia, and fibulae. Nine-month follow-up tumor imaging with Tc-99m MIBI revealed disappearance of the preoperative uptake of multiple brown tumor.

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Journal

Journal ID (nlm-ta): J Res Med Sci

Journal ID (publisher-id): JRMS

Title: Journal of Research in Medical Sciences : The Official Journal of Isfahan University of Medical Sciences

Publisher: Medknow Publications Pvt Ltd (India )

ISSN (Print): 1735-1995

ISSN (Electronic): 1735-7136

Publication date (Print): August 2011

Volume: 16

Issue: 8

Pages: 1078-1081

Affiliations

[1- ] Medicina Interna 1 B, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milano, Italy

[2- ] Nuclear Medicine, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milano, Italy

[3- ] Medicina Interna 1 A, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milano, Italy

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Corresponding Author: Lorena Airaghi E-mail: lorena.airaghi@ 123456pohchnico.mi.it

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Publisher ID: JRMS-16-1078

PMC ID: 3263086

PubMed ID: 22279485

SO-VID: e20bbaf4-0519-4064-9299-6ad28174ebfa

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This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Unusual presentation in a case of primary hyperparathyroidism

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Most cited references 13

Presentation of asymptomatic primary hyperparathyroidism: proceedings of the third international workshop.

The changing presentation of hyperparathyroidism over 3 decades.

Multiple brown tumors in parathyroid carcinoma mimicking metastatic bone disease.

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