Endocrine Abstracts

We report the case of 57-year-old man with end-stage renal disease, primary hyperparathyroidism and after an surgery of upper parathyroid glands with ectopic parathyroid localized in lung. Patient was directed to our hospital to perform diagnostics on hyperparathyroidism. Two years earlier (2011) patient was hospitalized because of weakness and weight loss, and was diagnosed with primary hyperparathyroidism. In 2012 he underwent the bilateral parathyroidectomy of upper glands which resulted in a reduction of PTH to correct values. Patent was repeatedly dialyzed just before the surgery because of renal failure. After the surgery patient was qualified to chronic dialysis because of end-stage renal disease. In 2012 during the hospitalization due to pneumonia, tumor in right upper lobe has been revealed in X-ray and CT of chest. Laboratory tests showed gradual re-increase of PTH. The neck CT did not show presence of parathyroid gland. MIBI parathyroid scan did not reveal any focus of increased uptake of radioisotope marker as well. Patient declared back pain escalating in sitting position. Laboratory tests revealed hypercalcemia, correct level of plasma phosphate and increased level of PTH- 3094 pg/ml. Chest CT scan was made once again and larger nodule in lung was found. Its intense uptake after contrast perfusion indicated high risk of neoplasmatic process. Owing to suspicion of lung neoplasm and bones pain, the bones scintigraphy was made as well, but it did not reveal traits specific to metastasis or brown tumor. Pulmonary nodule presented in MIBI-SPECT-CT showed increased uptake of radioactive marker which suggested neoplasmatic process. Considering clinical symptoms raising the probability of PTH secretion by the lung tumor and its growth, the patient was qualified for surgery. Intraoperative histopatology examination did not reveal malignant neoplasmatic lesion. PTH level lowered to 166.7 pg/ml.