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Rare Skeletal Complications in the Setting of Primary Hyperparathyroidism.

Sabanis N, Gavriilaki E, Paschou E, Kalaitzoglou A, Papanikolaou D, Ioannidou P, Vasileiou S - Case Rep Endocrinol (2015)

Bottom Line: Parathyroid carcinoma represents an extremely rare neoplasm with diverse clinical manifestations which vary from asymptomatic patients to severe complications of hypercalcemia or parathyrotoxicosis while skeletal involvement is rather common.Herein we aimed at presenting a unique case of a young patient with rare aggressive skeletal complications of parathyroid cancer that initially were misdiagnosed.Ossification of the cervical ligamentum flavum and skull tumor illustrates erosive bonny lesions of hyperparathyroidism that in association with previous medical history of recurrent nephrolithiasis and biochemical findings guide the diagnosis.

View Article: PubMed Central - PubMed

Affiliation: Department of Nephrology, General Hospital of Pella, 58200 Edessa, Greece.

ABSTRACT
Parathyroid carcinoma represents an extremely rare neoplasm with diverse clinical manifestations which vary from asymptomatic patients to severe complications of hypercalcemia or parathyrotoxicosis while skeletal involvement is rather common. Herein we aimed at presenting a unique case of a young patient with rare aggressive skeletal complications of parathyroid cancer that initially were misdiagnosed. Ossification of the cervical ligamentum flavum and skull tumor illustrates erosive bonny lesions of hyperparathyroidism that in association with previous medical history of recurrent nephrolithiasis and biochemical findings guide the diagnosis. We suggest that increased awareness and holistic approach are needed in order to recognize and further investigate signs and symptoms of hyperparathyroidism.

No MeSH data available.


Related in: MedlinePlus

A 45-year-old man with parathyroid carcinoma: (a) Technetium-99m Sestamibi scan and (b) Magnetic Resonance Imaging scan showing the parathyroid tumor.
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fig2: A 45-year-old man with parathyroid carcinoma: (a) Technetium-99m Sestamibi scan and (b) Magnetic Resonance Imaging scan showing the parathyroid tumor.

Mentions: During his hospitalization the patient's history and medical records were carefully reviewed. As shown in Figure 1, the patient had been suffering from misdiagnosed complications of hyperparathyroidism for the last two years. Based on his history, neck ultrasound and Technetium-99m Sestamibi scan were performed revealing a parathyroid tumor, as shown in Figure 2. Thorax and abdomen Computed Tomography were performed revealing no further pathological findings as well as neck Magnetic Resonance Imaging. No genetic testing was performed, in spite of the young age of the patient, because of the absence of familial history of multigland disease as well as clinical and imaging findings compatible to an inherited form of hyperparathyroidism [2]. Due to the persistently high serum calcium and parathyroid hormone levels, the high alkaline phosphatase levels (440.0 IU/L with normal values 38.0–155.0 IU/L), and the late complications of hyperparathyroidism, surgical excision of the tumor was scheduled. Meanwhile, the patient was treated with intravenous administration of normal saline 0.9% and renal adapted dosage of zoledronic acid (3 mg, MDRD eGFR = 52 mL/min/1.73 m2). As a result, preoperative serum calcium and creatinine levels were improved. According to the histopathology the tumor was identified as parathyroid carcinoma and total surgical excision was achieved.


Rare Skeletal Complications in the Setting of Primary Hyperparathyroidism.

Sabanis N, Gavriilaki E, Paschou E, Kalaitzoglou A, Papanikolaou D, Ioannidou P, Vasileiou S - Case Rep Endocrinol (2015)

A 45-year-old man with parathyroid carcinoma: (a) Technetium-99m Sestamibi scan and (b) Magnetic Resonance Imaging scan showing the parathyroid tumor.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4664786&req=5

fig2: A 45-year-old man with parathyroid carcinoma: (a) Technetium-99m Sestamibi scan and (b) Magnetic Resonance Imaging scan showing the parathyroid tumor.
Mentions: During his hospitalization the patient's history and medical records were carefully reviewed. As shown in Figure 1, the patient had been suffering from misdiagnosed complications of hyperparathyroidism for the last two years. Based on his history, neck ultrasound and Technetium-99m Sestamibi scan were performed revealing a parathyroid tumor, as shown in Figure 2. Thorax and abdomen Computed Tomography were performed revealing no further pathological findings as well as neck Magnetic Resonance Imaging. No genetic testing was performed, in spite of the young age of the patient, because of the absence of familial history of multigland disease as well as clinical and imaging findings compatible to an inherited form of hyperparathyroidism [2]. Due to the persistently high serum calcium and parathyroid hormone levels, the high alkaline phosphatase levels (440.0 IU/L with normal values 38.0–155.0 IU/L), and the late complications of hyperparathyroidism, surgical excision of the tumor was scheduled. Meanwhile, the patient was treated with intravenous administration of normal saline 0.9% and renal adapted dosage of zoledronic acid (3 mg, MDRD eGFR = 52 mL/min/1.73 m2). As a result, preoperative serum calcium and creatinine levels were improved. According to the histopathology the tumor was identified as parathyroid carcinoma and total surgical excision was achieved.

Bottom Line: Parathyroid carcinoma represents an extremely rare neoplasm with diverse clinical manifestations which vary from asymptomatic patients to severe complications of hypercalcemia or parathyrotoxicosis while skeletal involvement is rather common.Herein we aimed at presenting a unique case of a young patient with rare aggressive skeletal complications of parathyroid cancer that initially were misdiagnosed.Ossification of the cervical ligamentum flavum and skull tumor illustrates erosive bonny lesions of hyperparathyroidism that in association with previous medical history of recurrent nephrolithiasis and biochemical findings guide the diagnosis.

View Article: PubMed Central - PubMed

Affiliation: Department of Nephrology, General Hospital of Pella, 58200 Edessa, Greece.

ABSTRACT
Parathyroid carcinoma represents an extremely rare neoplasm with diverse clinical manifestations which vary from asymptomatic patients to severe complications of hypercalcemia or parathyrotoxicosis while skeletal involvement is rather common. Herein we aimed at presenting a unique case of a young patient with rare aggressive skeletal complications of parathyroid cancer that initially were misdiagnosed. Ossification of the cervical ligamentum flavum and skull tumor illustrates erosive bonny lesions of hyperparathyroidism that in association with previous medical history of recurrent nephrolithiasis and biochemical findings guide the diagnosis. We suggest that increased awareness and holistic approach are needed in order to recognize and further investigate signs and symptoms of hyperparathyroidism.

No MeSH data available.


Related in: MedlinePlus