scholarly journals A Rare Case of Severe Hypercalcemia Secondary to Atypical Parathyroid Cystic Adenoma with Negative Sestamibi Scan

Cureus ◽  
2020 ◽  
Author(s):  
Elio P Monsour ◽  
Faysal Rifai ◽  
Jay Chacko ◽  
Alan Hamza ◽  
Khalid Abusaada
Keyword(s):  
Rare Case ◽  
Severe Hypercalcemia ◽  
Sestamibi Scan ◽  
Cystic Adenoma

scholarly journals Rare Case of Severe Hypercalcemia Secondary to Atypical Sestamibi Negative Parathyroid Cystic Adenoma

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A266-A267
Author(s):  
Timur Gusov ◽  
John Chen Liu ◽  
Sowjanya Naha ◽  
F N U Marium ◽  
Joseph Theressa Nehu Parimi ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
Parathyroid Adenoma ◽  
Parathyroid Gland ◽  
Severe Hypercalcemia ◽  
Parathyroid Adenomas ◽  
Sestamibi Scan ◽  
Serum Pth ◽  
The Right ◽  
99Mtc Sestamibi ◽  
Cystic Adenoma

Abstract Primary hyperparathyroidism (PHPT) is defined as excessive secretion of parathyroid hormone (PTH) originating from the parathyroid gland. The most common cause is a single parathyroid adenoma which is typically solid. Cystic parathyroid adenomas (CPA) are the cause of about 1–2% of cases of primary hyperparathyroidism. It is known that cystic parathyroid adenomas are a result of degeneration of an existing parathyroid adenoma. SestaMIBI is an imaging study based on uptake of radioactive technetium99 and used to localize parathyroid adenomas. We describe an unusual case of severe hypercalcemia secondary to 99mTc sestaMIBI negative atypical parathyroid cystic adenoma. A 56-year-old male presented to our facility with nausea and vomiting. His past medical history included hypertension and hepatitis C with no history of fractures or kidney disease. Physical examination was normal. Upon admission the patient was afebrile with blood pressure of 170/120 mmHg and heart rate of 62 bpm. Chemistry showed Calcium of 14.5 mg/dL (8.6–10.2mg/dL), phosphorus 2.2 (2.7–4.5) mh/dL, magnesium 1.8 (1.7–2.6)mg/dL, intact PTH of 375 (15–65) pg/mL, PTH-related peptide <2.0 pmol/L(<2 pmol/L), 25-OH vitamin D of 19 ng/ml (30–80), Creatinine 1.22 (0.7–1.2)mg/dL, alkaline phosphatase 95 (40–129) units/L. He was started on aggressive hydration, calcitonin 4 units/kg, 4 mg of IV Zolendroninc acid. Neck sonogram revealed a large, complex, predominantly anechoic lesion with solid vascular components and thick internal septations in the inferior and medial aspect of the right thyroid lobe measuring 3 x 2 x 5.5 cm. Findings were confirmed with CT of the neck. Since Sestamibi scan (planar and SPECT/CT) did not show uptake in parathyroid glands, the cyst was thought to be of thyroid origin. Fine needle aspiration was not able to detect cellular material, but PTH was >100 pg/ml on the FNA sample. Otolaryngology service was consulted for parathyroidectomy. During the surgical treatment, the right upper parathyroid gland was removed with no changes in serum PTH. Next, the cystic lesion was removed with normalization of serum PTH (from 218 pg/ml to 35.2 pg/ml respectively). Intraoperative frozen section analysis was read as a cystic parathyroid adenoma. The final pathology report revealed cystic parathyroid tissue favoring parathyroid adenoma with focal atypia. Hypercalcemia resolved. Conclusions: Atypical cystic parathyroid adenomas are a rare cause of PHPT. 90% of parathyroid cysts are nonfunctional. Above mention is a case of a patient presenting with hypercalcemic crisis secondary to cystic parathyroid adenoma, which posed a diagnostic challenge as both neck ultrasound and 99mTc sestaMIBI scan were inconclusive. These findings should trigger suspicion for functional parathyroid lesions. Cystic components should be evaluated for PTH levels and if significantly elevated should be treated as a parathyroid adenoma.

Abstract #830: Rare Case of Severe Hypercalcemia: Gauchers Disease

2016 ◽  
Vol 22 ◽  
pp. 176-177
Author(s):  
Sudhamshi Toom ◽  
Elizabeth Sedlis Singer
Keyword(s):  
Rare Case ◽  
Severe Hypercalcemia

scholarly journals PARATHYROMATOSIS: A RARE CASE OF RECURRENT HYPERPARATHYROIDISM LOCALIZED BY FOUR-DIMENSIONAL COMPUTED TOMOGRAPHY

2019 ◽  
Vol 5 (6) ◽  
pp. e384-e387 ◽  
Author(s):  
Abraham E. Wei ◽  
Matthew R. Garrett ◽  
Ankur Gupta
Keyword(s):  
Computed Tomography ◽  
Rare Case ◽  
Clinical Laboratory ◽  
Parathyroid Tissue ◽  
Severe Hypercalcemia ◽  
Positron Emission ◽  
Affected Tissue ◽  
History Of ◽  
The Right ◽  
Recurrent Hyperparathyroidism

Objective: To present a rare case of parathyromatosis. Methods: We present the clinical, laboratory, and imaging findings, along with a review of the literature. Results: A 33-year-old man with a history of right upper parathyroid adenoma removal 5 years prior due to hyperparathyroidism was admitted for severe hypercalcemia (15.6 mg/dL; normal, 8.5 to 10.5 mg/dL) with elevated plasma parathyroid hormone (PTH) (882 pg/mL; normal, 15 to 65 pg/mL). Ultrasound, computed tomography (CT), sestamibi, and positron emission tomography scans were unremarkable; however, a four-dimensional CT (4DCT) of the neck showed an area of increased signal enhancement and hypervascularity without discrete nodule in the posterior right thyroid region. The patient underwent parathyroid surgical exploration with right hemithyroidectomy and compartment neck dissection to remove the affected tissue. PTH levels dropped to 208 pg/mL postoperatively; calcium decreased but remained elevated at 12.7 mg/dL. Pathology revealed the presence of several small nodular foci of atypical hyperplastic parathyroid tissue in the right thyroid and soft tissue in the left central neck compartment consistent with parathyromatosis. Conclusion: This case report represents the first-time use of 4DCT to localize parathyromatosis. Parathyromatosis is a rare but problematic cause of recurrent hyperparathyroidism. Ultrasound and 4DCT may represent the best imaging modalities for identification and perioperative management to remove all affected tissue without reseeding.

scholarly journals A rare case of hypercalcemia-induced pancreatitis in a first trimester pregnant woman

2018 ◽  
Vol 2018 ◽  
Author(s):  
Carine Ghassan Richa ◽  
Khadija Jamal Saad ◽  
Ali Khaled Chaaban ◽  
Mohamad Souheil El Rawas
Keyword(s):  
Acute Pancreatitis ◽  
Pregnant Woman ◽  
Primary Hyperparathyroidism ◽  
Rare Case ◽  
First Trimester ◽  
List Type ◽  
Second Trimester ◽  
Adequate Treatment ◽  
Severe Hypercalcemia ◽  
First Trimester Of Pregnancy

Summary The objective of the study is to report a case of acute pancreatitis secondary to hypercalcemia induced by primary hyperparathyroidism in a pregnant woman at the end of the first trimester. The case included a 32-year-old woman who was diagnosed with acute pancreatitis and severe hypercalcemia refractory to many regimens of medical therapy in the first trimester of pregnancy. She was successfully treated with parathyroidectomy in the early second trimester with complete resolution of hypercalcemia and pancreatitis. Neonatal course was unremarkable. To our best knowledge, this is a rare case when primary hyperparathyroidism and its complications are diagnosed in the first trimester of pregnancy. In conclusion, primary hyperparathyroidism is a rare life-threatening condition to the fetus and mother especially when associated with complications such as pancreatitis. Early therapeutic intervention is important to reduce the morbidity and mortality. Parathyroidectomy performed in the second trimester can be the only solution. Learning points: Learning how to make diagnosis of primary hyperparathyroidism in a woman during the first trimester of pregnancy. Understanding the complications of hypercalcemia and be aware of the high mortality and sequelae in both fetus and mother. Providing the adequate treatment in such complicated cases with coordinated care between endocrinologists and obstetricians to ensure optimal outcomes.

scholarly journals A rare case of tuberculosis-induced hypercalcemia

2020 ◽  
Vol 30 (3) ◽  
pp. 471-474
Author(s):  
Loris Wauthier ◽  
Xavier Theunssens ◽  
Patrick Durez ◽  
Catherine Fillée ◽  
Diane Maisin ◽  
...  
Keyword(s):  
Biochemical Parameters ◽  
Rare Case ◽  
Disease Modifying Antirheumatic Drugs ◽  
Antirheumatic Drugs ◽  
Atypical Case ◽  
Severe Hypercalcemia ◽  
Laboratory Investigations ◽  
Disease Modifying ◽  
25 Oh Vitamin D

Laboratory investigations of hypercalcemia involve testing of various biochemical parameters such as parathyroid hormone (PTH), 25-(OH) Vitamin D (25-(OH) VitD), 1,25-(OH)2 Vitamin D3 (calcitriol) and PTH related peptide (PTHrp). We herein present an atypical case of severe hypercalcemia in a patient with rheumatoid arthritis who has been treated for years by various biological disease-modifying antirheumatic drugs (DMARDs) and suddenly presented with general state alteration, oedema and ulceration of her right ankle. We illustrate how tuberculosis (TB) can cause high calcitriol concentration and subsequently lead to potentially severe hypercalcemia. Moreover, we highlight the importance of TB testing and follow-up in patients treated with biological DMARDs.

scholarly journals S2140 A Rare Case of Undifferentiated Neuroendocrine Esophageal Carcinoma With Severe Hypercalcemia

2021 ◽  
Vol 116 (1) ◽  
pp. S920-S920
Author(s):  
Brittney Shupp ◽  
Nishit Patel ◽  
Anthony Cianciolo ◽  
Hammad Liaquat ◽  
Lisa Stoll ◽  
...  
Keyword(s):  
Esophageal Carcinoma ◽  
Rare Case ◽  
Severe Hypercalcemia

scholarly journals Hypercalcemia of malignancy in metastatic adenocarcinoma of left lower eyelid - A report of a rare case

2021 ◽  
Vol 7 (2) ◽  
pp. 210-212
Author(s):  
Divya BM ◽  
Shylashree ◽  
Muthukumar Mani
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Paraneoplastic Syndrome ◽  
Rare Case ◽  
Lower Eyelid ◽  
Treatment Modalities ◽  
Metastatic Adenocarcinoma ◽  
Eyelid Skin ◽  
Severe Hypercalcemia ◽  
Time Of Presentation

Adenocarcinoma of eyelid is a rare disease with an incidence of 1 to 5.5% and is considered to be the most common eyelid malignancy following basal cell and squamous cell carcinoma. The symptoms usually present as swelling, thickening, change in appearance of the eyelid skin and ulceration. Various treatment modalities include surgery, radiation or chemotherapy relying upon the stage of tumor at the time of presentation. However, metastasis of adenocarcinoma of the eyelid to other organs is quite rare. We are presenting a case of a 35 year old male who initially presented with complaints of watering in the left eye and in due course, was diagnosed with adenocarcinoma of eyelid which was being treated and eventually progressed to lung and skeletal tissues.  This gentleman also had severe Hypercalcemia which was secondary to paraneoplastic syndrome.

scholarly journals A Case of Acute Psychosis in an Adolescent Male

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Ghufran Babar ◽  
Ramin Alemzadeh
Keyword(s):  
Pediatric Population ◽  
Left Lobe ◽  
Adolescent Male ◽  
Psychotic Symptoms ◽  
Acute Psychosis ◽  
Ipth Level ◽  
Behavioral Issues ◽  
Severe Hypercalcemia ◽  
Sestamibi Scan ◽  
Clinical Clue

Primary hyperparathyroidism (PHPT) is a disorder of calcium homeostasis. We report the case of a 17-year-old adolescent male, who presented with an acute psychosis coinciding with severe hypercalcemia and markedly elevated intact parathyroid hormone (iPTH) level and low vitamin D level. A Sestamibi scan showed a positive signal inferior to the left lobe of the thyroid gland. He had only a partial response to the initial medical and psychiatric management. The enlarged parathyroid gland was resected surgically and postoperatively serum calcium and iPTH levels normalized. The histopathology was compatible with a benign adenoma. Patient’s acute psychotic symptoms resolved gradually after surgery; however he remained under psychiatric care for the behavioral issues for about 6 months after surgery. While psychosis is a rare clinical manifestation of hypercalcemia secondary to PHPT in pediatric population, it should be considered as a clinical clue in an otherwise asymptomatic pediatric patient.

Identification of Pulmonary Deposits from a Sandpaper Worker: A Study by Electron Microscopy and X-Ray Microanalysis

1982 ◽  
Vol 40 ◽  
pp. 52-53
Author(s):  
S. K. Peng ◽  
M.A. Egy ◽  
J. K. Singh ◽  
M.B. Bishop
Keyword(s):  
Electron Microscopy ◽  
Environmental Pollution ◽  
Rare Case ◽  
Interstitial Fibrosis ◽  
X Ray ◽  
Documented Case ◽  
Etiologic Agents ◽  
Pulmonary Interstitial Fibrosis ◽  
Gold Miners ◽  
Pulmonary Changes

Electron microscopy and energy dispersive x-ray microanalysis (EDXA) are found to be very useful tools for identification of etiologic agents in pneumoconiosis or interstitial pulmonary disorders. Pulmonary interstitial fibrosis and granulomatosis are frequently associated with occupational and environmental pollution. Numerous reports of pneumoconiosis in various occupations such as coal and gold miners are presented in the literature. However, there is no known documented case of pulmonary changes in workers in the sandpaper industry. This study reports a rare case of pulmonary granulomatosis containing deposits from abrasives of sandpaper diagnosed by using EDXA.

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