A rare case of triple parathyroid adenoma with hyperparathyroidism occurring at a young age

G Gonca Oruk; Mehmet Haciyanli; Melike Bedel Koruyucu; Ebru Ruksen; Ozlem Gur; Cengiz Tavusbay; Husnu Yilmaz; Baris Pamuk

doi:10.1530/endoabs.37.EP1254

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Endocrine Abstracts (2015) 37 EP1254 | DOI: 10.1530/endoabs.37.EP1254

ECE2015 Eposter Presentations Clinical Cases–Thyroid/Other (101 abstracts)

A rare case of triple parathyroid adenoma with hyperparathyroidism occurring at a young age

G Gonca Oruk ¹ , Mehmet Haciyanli ² , Melike Bedel Koruyucu ³ , Ebru Rüksen ⁴ , Ozlem Gur ² , Cengiz Tavusbay ² , Husnu Yilmaz ¹ & Baris Pamuk ¹

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¹Division of Endocrinology and Metabolism, Ataturk Training and Research Hospital, Izmir Katip Celebi University, Izmir, Turkey; ²Department of Surgery, Ataturk Training and Research Hospital, Izmir Katip Celebi University, Izmir, Turkey; ³Ataturk Training and Research Hospital, Ankara Yildirim Beyazit University, Ankara, Turkey; ⁴Deparment of Nuclear Medicine, Ataturk Training and Research Hospital, Izmir Katip Celebi University, Izmir, Turkey.

Lesions causing primary hyperparathyroidism (PHP) can be summarised as solitary adenoma (80–85%), multiglandular hyperplasia (15%), parathyroid carcinoma (1%). While double adenomas are identified in 2–15% of the patients which are operated for PHP, triple adenomas are very rare. The case is presented because in the recent years patients who are admitted to the hospital with intense bone complaints are very unusual and multiple adenomas are also seldom. 22 years old female patient was admitted to orthopaedics outpatient clinic with symptoms of severe pain with activity and mass at proximal area of left femur. During evaluation calcium and parathyroid hormone (PTH) levels were discovered to be high. Calcium: 11.8 mg/dl, phosphorus: 2.2 mg/dl, alkaline phosphotase (ALP): 1275 U/l, PTH: 2754 pg/ml, 24 h urine calcium: 288 mg/day, BUN: 5 mg/dl, creatinine: 0.41 mg/dl, 25 (OH) D Vitamin: 3.2 μg/l. Thyroid doppler ultrasonography revealed a 20×17×7 mm mass at the right lobe of the thyroid and at the caudal region of this lesion a 13×11×9 mm mass, also a 36×22×23 mm lesion at the left lobe of the thyroid continuing to the mediastinum consistent with right and left-sided parathyroid adenomas. 20 mCi Tc-99m MIBI SPECT images demonstrated hyperdense activity only at the left side. Before the operation the patient was screened for multiple endocrine neoplasia because of her young age, results were negative. After the operation three parathyroid adenomas were discovered and PTH and calcium levels regressed to 10 pg/ml and 8.4 mg/dl respectively. Usually PHP is expected to occur at later stages of life, but PHP should also be kept in mind in patients with serious bone complaints, high calcium and PTH levels. Early diagnosis and appropriate treatment can be prevent morbidity and mortality related with PHP.