Endocrine Abstracts

We present the case of a 51-year-old gentleman who had a giant parathyroid adenoma. He has a past medical history of deep vein thrombosis and hypertension. He is taking amlodipine 10 mg od. He is a non-smoker and drinks alcohol in moderation. He was admitted with right leg swelling found to be a new thrombosis. Incidental finding of extreme hypercalcaemia found on bloods with raised PTH (CorrCa 4.23 mmol/l, PTH 83.1 pmol/l.) Patient was completely asymptomatic. CT imaging of chest, abdomen and pelvis demonstrated extensive above knee thrombosis, renal calculi and a large thyroid nodule. However, an ultrasound and Sestamibi confirmed spectacularly this was an enlarged parathyroid. He was anticoagulated with heparin and then oral anticoagulant. He was given aggressive i.v. fluids and bisphosphonate with limited effect so cinacalcet was initiated. We were still unable to control calcium levels and so in patient parathyroidectomy was performed. At operation the gland appeared grossly enlarged and vascular. However, there was no tethering to adjacent tissues and easily removed weighing 43 g. Our patient made a good recovery with normalisation of calcium. Histology showed features in keeping with parathyroid adenoma rather than carcinoma. On review in clinic two months later he remains normocalcemic. A DEXA has shown osteoporosis which we expect to improve in time.

Our case is interesting as there are features of this case in keeping with parathyroid malignancy rather than adenoma and we shall discuss this.