ECE2014 Poster Presentations Calcium and Vitamin D metabolism (68 abstracts)
Persistant hypercalcemia due to an atypically localised parathyroid adenoma in a patient operated from parathyroid carcinoma: a report of case
Oya Topaloglu 1 , Bekir Ucan 2 , Muyesser Sayki Arslan 2 , Mehmet Kilic 3 , Melia Karakose 2 , Guleser Saylam 4 , Elif Ozdemir 5 , Erman Cakal 2 & Tuncay Delibasi 2
1Department of Endocrinology and Metabolism, Yildirim Beyazit University, Atatürk Education and Research Hospital, Ankara, Turkey; 2Department of Endocrinology and Metabolism, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey; 3Department of General Surgery, Yildirim Beyazit University, Atatürk Education and Research Hospital, Ankara, Turkey; 4Department of Otorhinolaryngology, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey; 5Department of Nuclear Medicine, Atatürk Education and Research Hospital, Ankara, Turkey.
Introduction: Patients with parathyroid carcinoma (PCA) and synchronous disease in other parathyroid glands have been reported in the literature. Here, we report a patient who had persistant hypercalcemia after operated from parathyroid carcinoma and improvement of hypercalcemia after the subsequent operation from atypically localised parathyroid adenoma.
Case report: A 62-year-old man presented with a history of headache, fatigue, and nervousness. Laboratory investigation demonstrated hypercalcemia (11.1 mg/dl) and elevated parathyroid hormone (PTH) level (528 pg/ml). Neck ultrasound revealed multinodular goiter and a 12×24×44 mm parathyroid tumor adjacent to the left thyroid lobe. Because of the cystic components of the parathyroid mass in the ultrasound, parathyroid cancer was suspected. A sestamibi scan was negative. An en bloc resection of the parathyroid mass, and total thyroidectomy was performed. Histopathological examination showed parathyroid carcinoma. Serum calcium and PTH levels were persistently elevated in the postoperative follow-up period. Neck ultrasound was performed and a 8 mm hypoechoic lesion suspicious for in the right parathyroid region was detected. In whole body sestamibi scintigraphy there was an increased uptake in the right parathyroid region. Second operation was not successful for excision of adenoma. On the 10th month of the first operation his calcium was 11.1 mg/dl and PTH 251 pg/ml. Sestamibi/SPECT/CT and neck CT was revealed a lesion in the toracic inlet. The patient underwent third operation and parathyroid adenoma-like lesion was excised distal to the brachio-cephalic artery and bifurcation of common carotid artery and subclavian artery. Histopathological evaluation was parathyroid adenoma. The patient became hypocalcemic on his first postoperative day and treated with i.v. and oral calcium, calcitriol. He was eventually discharged with oral calcium and calcitriol supplementation.
Conclusion: Synchronous parathyroid carcinoma and parathyroid adenoma are extremely rare. The presence of concurrent disease in other parathyroid glands must be kept in mind.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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