Category: Calcium/Bone Disorders

Type: e-Poster

Monitor: 25

25 - GIANT CELL TUMOR - OSTEOCLASTOMA OF THE SPINE AS THE INAUGURAL PRESENTATION OF PRIMARY HYPERPARATHYROIDISM AND GIANT PARATHYROID ADENOMA

Thursday, Apr 25
11:00 AM – 11:30 AM

Objective :

Story of 2 giants: To describe giant cell tumor – osteoclastoma of the spine as the inaugural presentation of primary hyperparathyroidism [PHP] and giant parathyroid adenoma.


Methods :

62 year female hypertensive, presented with pain lower limbs and lower back x 2 months and mild azotaemia. MRI Spine showed enhancing lytic expansile lesion of L4 vertebra with significant bony central spinal canal compromise. She underwent L4 laminectomy with decompression of intradural extramedullary lesion. Histopathology:  Grade I Osteoclastoma – Giant cell tumor.


Results :

In view of the histopathology report, patient was further evaluated which revealed severe hypercalcemia (17.5mg/dl). Serum electrophoresis negative. Parathormone level was very high (1243.50 pg/ml) - Diagnosis PHP. Ultrasound of neck revealed a large left paratracheal tumor postero-inferior to left lobe of thyroid, with retrosternal extension suggestive of parathyroid tumor. This finding was confirmed by 99m Tc-Sestamibi scan. Patient also had multiple tiny calculi in both kidneys (non obstructive) and subtle osteoporotic changes in bones of both hands on x ray.


In the meantime, aggressive volume expansion by intravenous normal saline was done, which controlled hypercalcemia and also her renal function improved. Thus, after stabilization, patient was taken up for parathyroid surgery under general anaesthesia. There was an encapsulated large tumor of about 7cm in largest dimension weighing about 60 grams.


Immediate post operative PTH levels significantly dropped to 182 pg/dl. Serum calcium was monitored regularly and oral calcium supplementation was started on 2nd post operative day, when the serum calcium started dropping steadily. PTH on 4th post operative day was 11.30 pg/dl and patient was started on alfacalcidiol. Patient also had hypomagnesemia which was corrected adequately and her renal parameters also normalized. Histopathological examination of the resected specimen was suggestive of parathyroid adenoma. Patient improved significantly without any complications and she is now on regular follow up.


Discussion :

PHP has a variable clinical presentation in which musculoskeletal symptoms predominate, and it should be always remembered as one of the causes of orthopaedic / rheumatologic manifestations [osteoporosis, fractures, fibrous cystic osteitis, osteoarthritis, diffuse arthralgia, fibromyalgia, chondrocalcinosis, and tendinopathies].


Conclusion :

We report a case of giant parathyroid adenoma [60 grams: the largest in our series] presenting with spinal osteoclastoma. Brown tumor of the thoracic spine as the first manifestation of primary hyperparathyroidism has been very rarely reported.

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Babitha D. T

Consultant Faculty Endocrinology Diabetes
Samatvam Jnana Sanjeevini Diabetes Hospital and Medical Center
Bangalore, Karnataka, India

Designation: Consultant and Faculty
Specialties: Endocrinology, Diabetes
Clinical Interests: Endocrine disorders of pregnancy, Pregnancy Diabetes, Cardiovascular Health, Thyroid, Inpatient diabetes care and endocrine metabolic emergencies

Kavitha Muniraj

Consultant Faculty Endocrinology Diabetes
Samatvam Jnana Sanjeevini Diabetes Hospital and Medical Center
Bangalore, Karnataka, India

Designation: Consultant and Faculty; Director Medical ; Director Research; Trustee
Specialties: Endocrinology Diabetes; Clinical Research
Clinical Interests: Pituitary Adrenal disorders; Bone health; Cardiovascular Health; Thyroid dysfunction; Diabetes Pharmacotherapy; Clinical Pharmacology; Pharmacovigilance; Clinical research Safety and Audits

Reshma B. Vijay

Consultant Faculty Endocrinology Diabetes
Samatvam Jnana Sanjeevini Diabetes Hospital and Medical Center
Bangalore, Karnataka, India

Designation: Consultant and Faculty
Specialties: Endocrinology Diabetes and Metabolism
Clinical Interests: Pediatric Endocrinology; Diabetes mellitus; Insulin Pumps, Continuous Glucose Monitoring and Artificial Pancreas; Growth and Puberty; Thyroid; Pituitary Adrenal disorders

Vasanthi Nath

Consultant Faculty Endocrinology Diabetes
Samatvam Jnana Sanjeevini Diabetes Hospital and Medical Center
Bangalore, Karnataka, India

Designation: Consultant and Faculty
Specialties: Endocrinology, Diabetes, Internal Medicine, Geriatrics
Clinical Interests: Neuroendocrinology and Neurometabolism, Metabolic Myopathies; Thyroid tumors, Geriatric Endocrinology, Inpatient Diabetes Care and Endocrine Emergencies; Type 1 diabetes across ages

Chandraprabha S

Consultant Faculty Endocrinology Diabetes
Samatvam Jnana Sanjeevini Diabetes Hospital and Medical Center
Bangalore, Karnataka, India

Designation: Consultant and Faculty
Specialties: Endocrinology Diabetes Metabolism
Clinical Interests: Pregnancy Diabetes, Pregnancy Thyroid Dysfunction, Women Health, Geriatric Endocrinology, Diabetes mellitus and Mental Health, Spiritual Medicine

Muralidhara Krishna

Consultant Faculty Endocrinology Diabetes Biochemistry
Samatvam Jnana Sanjeevini Diabetes Hospital and Medical Center
Bangalore, Karnataka, India

Designation: Consultant and Faculty: Endocrinology Diabetes Metabolism; Associate Professor: Clinical Biochemistry and Laboratory Medicine
Specialties: Endocrinology Diabetes Metabolism; Clinical Biochemistry
Clinical Interests: Diabetes mellitus; Thyroid Disorders; Obesity; Dyslipidemia.

Jayalakshmi T

Consultant Faculty Endocrinology Diabetes
Samatvam Jnana Sanjeevini Diabetes Hospital and Medical Center
Bangalore, Karnataka, India

Designation: Consultant and Faculty

Specialties: Endocrinology, Diabetes, Internal Medicine,
Clinical Interests: Diabetes mellitus, Cardiovascular Health, Thyroid, In Patient Diabetes Care, Endocrinology Metabolic emergencies and critical care

Nidhi Garg

Consultant Faculty Endocrinology Diabetes
Samatvam Jnana Sanjeevini Diabetes Hospital and Medical Center
bangalore, Karnataka, India

Designation: Senior Consultant and Faculty
Specialties: Diabetes and Metabolism
Clinical Interests: Comprehensive diabetes care, In-patient diabetes and metabolic care, Perioperative diabetes management, Diabetes and endocrine emergencies – Metabolic Intensive Care, Obesity management, Lipids and preventive cardiology, Gestational diabetes, Thyroid disorders, Type 1 diabetes across ages

Apoorva Govind

Consultant Faculty Endocrinology Diabetes
Samatvam Jnana Sanjeevini Diabetes Hospital and Medical Center
Bangalore, India

Designation: (a) Fellow: Endocrinology Diabetes Medicine, Samatvam Endocrinology Diabetes Centre and Jnana Sanjeevini Medical Centre and Diabetes Hospital ; (b) Co Investigator – Clinical Research, Samatvam Science and Research Center

Specialties: Endocrinology, Diabetes, Internal Medicine

MD Chitra

Consultant Faculty Endocrinology Diabetes
Samatvam Jnana Sanjeevini Diabetes Hospital and Medical Center

Designation: Consultant and Faculty; Trustee
Specialties: Endocrinology Diabetes; Clinical Research
Clinical Interests: Diabetes, Obesity, Dyslipidemia, Osteoporosis, Pituitary Adrenal disorders; Bone health; Cardiovascular Health; Thyroid dysfunction;

Siddartha Dinesha

Resident, Medicine Diabetes Endocrinology
Samatvam Jnana Sanjeevini Diabetes Hospital and Medical Center

Designation: Resident: Medicine; Endocrinology Diabetes, Samatvam Endocrinology Diabetes Centre and Jnana Sanjeevini Medical Centre and Diabetes Hospital
Specialties: Endocrinology, Diabetes, Internal Medicine

Vasudha Srikanth


India

Sathvik Reddy Chinna Bainagari

Resident Doctor
Samatvam jnana sanjeevini Diabetes hospital and medical center
Chittoor, Andhra Pradesh, India

Madhumati S Vaishnav

Scientist Faculty
Samatvam Jnana Sanjeevini Diabetes Hospital and Medical Center; CENSE Indian Institute of Science, India

B.Sc (Microbiology), University of Pune, India.
M.Sc (Microbiology), University of Pune, India.
Post Graduate Diploma in Clinical Research and Clinical Data Management, University of Pune, India
CDE (Certified Diabetes Educator - Counselor), Samatvam Institute of Medical Sciences, India

Keerthana Haridas

Keerthana Haridas

Namya Gaekwad

Sri Srikanta