Endocrine Abstracts

Introduction: Primary hyperparathyroidism (PHPT) is a disease that is characterized by elevated calcium and parathyroid hormone levels. The most common cause of PHPT is the paratiroid adenoma and the first line treatment option is surgical removal of the adenoma. Rarely, the haemorrhage in the lesion may cause the spontaneous remission of the disease.

Case report: A 54-year-old woman patient with fatigue was referred to our department due to calcium level of 11.4 mg/dl (normal range: 8.4–10.2) and PTH level of 76.1 pg/ml (normal range: 15–65). Neck ultrasound examination revealed a 10×5 mm mass lesion in the posterior-inferior region of the left lobe of the thyroid. Sestamibi scan showed activity in the same region with neck ultrasound. Surgical resection of the parathyroid adenoma was planned but the patient refused surgical excision because of personal reasons. One year after the diagnosis of PHPT, her calcium concentration returned into the normal range (9.4 mg/dl), at the same time neck MRI showed a mass with a size of 19×13 mm, which was attached inferiorly to the left lobe of the thyroid. The mass was diagnosed as hemorrhagic parathyroid adenoma because the mass was imaged as a high intensity area by T₂-weighted MRI. At that time the sestamibi scan was negative. Six months after the haemorrhage of the lesion, it was seen that the calcium level rose to 11.1 mg/dl and the PTH level was 89 pg/ml so the PHPT has been recurred.

Conclusion: Parathyroid apoplexy can lead to spontaneous remission of the PHPT but the remission is usually temporary and finally recurrence of the disease could be seen.