Primary Hyperparathyroidism with SVT and hypertensive crises; to proceed or not to proceed with surgery?

Hassan Ibrahim; Christo Albor; Solat Hasnain; Ayaz Hussain; Jawad Bashir

doi:10.1530/endoabs.73.EP24

A pituitary hormonal profile and MRI pituitary was requested revealing eupituitary hormonal status with an incidental finding of 4 mm microadenoma. The case was discussed in local MDT and the outcome was to continue conservative management of PHPTH with cinacalcet until pheochromocytoma has been ruled out completely. Both MEN-1 and MEN-2 are associated with PHPTH. If a patient is having episodic adrenergic crises with inconclusive metanephrines analysis then excluding pheochromocytoma is important for perioperative safety. This case highlights the diagnostic work up in such cases.


Plasma metanephrine (results)
Plasma Metadrenaline	656 pmol/l	(80–510)
Plasma Normetadrenaline	2582 pmol/l	(120–1180)
Plasma 3-methoxytyramine	<120 pmol/l	(<120)
Urinary metanephrine:
Normetanephrine	4.56 umol/day	(<3.7)
Metanephrine	1.55 umol/day	(<1.3)
24 h Urine 3-methoxytyramine	0.82 umol/day	(<2.6)
30 min supine plasma metanephrine
Plasma Metadrenaline	375 pmol/l	(80–510)
Plasma Normetadrenaline	2100 pmol/l	(120–1180)
Plasma 3-methoxytyramine	<120 pmol/l	< 120

A pituitary hormonal profile and MRI pituitary was requested revealing eupituitary hormonal status with an incidental finding of 4 mm microadenoma. The case was discussed in local MDT and the outcome was to continue conservative management of PHPTH with cinacalcet until pheochromocytoma has been ruled out completely. Both MEN-1 and MEN-2 are associated with PHPTH. If a patient is having episodic adrenergic crises with inconclusive metanephrines analysis then excluding pheochromocytoma is important for perioperative safety. This case highlights the diagnostic work up in such cases.

Endocrine Abstracts

EP24