Novodvorsky, P., Hussein, Z., Arshad, M.F. et al. (4 more authors) (2019) Two cases of spontaneous remission of primary hyperparathyroidism due to auto-infarction : different management and their outcomes. Endocrinology Diabetes and Metabolism Case Reports, 2019 (1). ISSN 2052-0573
Abstract
Spontaneous remission of primary hyperparathyroidism (PHPT) due to necrosis and haemorrhage of parathyroid adenoma, the so-called ‘parathyroid auto-infarction’ is a very rare, but previously described phenomenon. Patients usually undergo parathyroidectomy or remain under close clinical and biochemical surveillance. We report two cases of parathyroid auto-infarction diagnosed in the same tertiary centre; one managed surgically and the other conservatively up to the present time. Case #1 was a 51-year old man with PHPT (adjusted (adj.) calcium: 3.11 mmol/L (reference range (RR): 2.20–2.60 mmol/L), parathyroid hormone (PTH) 26.9 pmol/L (RR: 1.6–6.9 pmol/L) and urine calcium excretion consistent with PHPT) referred for parathyroidectomy. Repeat biochemistry 4 weeks later at the surgical clinic showed normal adj. calcium (2.43 mmol/L) and reduced PTH. Serial ultrasound imaging demonstrated reduction in size of the parathyroid lesion from 33 to 17 mm. Twenty months later, following recurrence of hypercalcaemia, he underwent neck exploration and resection of an enlarged right inferior parathyroid gland. Histology revealed increased fibrosis and haemosiderin deposits in the parathyroid lesion in keeping with auto-infarction. Case #2 was a 54-year-old lady admitted with severe hypercalcaemia (adj. calcium: 4.58 mmol/L, PTH 51.6 pmol/L (RR: 1.6–6.9 pmol/L)) and severe vitamin D deficiency. She was treated with intravenous fluids and pamidronate and 8 days later developed symptomatic hypocalcaemia (1.88 mmol/L) with dramatic decrease of PTH (17.6 pmol/L). MRI of the neck showed a 44 mm large cystic parathyroid lesion. To date, (18 months later), she has remained normocalcaemic.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © 2019 The Author(s). This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (https://creativecommons.org/licenses/by-nc-nd/4.0/). |
Keywords: | 2019; Adult; Alkaline phosphatase; Appetite reduction/loss; Bisphosphonates; Black - Caribbean; Bone; Bone mineral density; CT scan; Calcium; Calcium (serum); Calcium (urine); Calcium carbonate; Cholecalciferol; Creatinine (serum); Fatigue; Female; Fine needle aspiration biopsy; Fluid repletion; Histopathology; Hypercalcaemia; Hyperparathyroidism (primary); Hypophosphataemia; MRI; Male; May; PTH; Pamidronate; Paraesthesia; Parathyroid; Parathyroid adenoma; Parathyroidectomy; Phosphate (serum); SPECT scan; Saline; Sestamibi scan; Ultrasound scan; Unique/unexpected symptoms or presentations of a disease; United Kingdom; Urine 24-hour volume; Vitamin D; Weight loss; White |
Dates: |
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Institution: | The University of Sheffield |
Academic Units: | The University of Sheffield > Faculty of Medicine, Dentistry and Health (Sheffield) > Department of Oncology (Sheffield) |
Depositing User: | Symplectic Sheffield |
Date Deposited: | 08 Jul 2019 13:08 |
Last Modified: | 08 Jul 2019 13:30 |
Status: | Published |
Publisher: | Bioscientifica |
Refereed: | Yes |
Identification Number: | 10.1530/edm-18-0136 |
Related URLs: | |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:147506 |