Category: Calcium/Bone Disorders
To present a case of Primary Hyperparathyroidism (PHPT) due to Parathyroid Adenoma and Parathyroid Hyperplasia.
Methods : The clinical and paraclinical characteristics of the patient are described.
Results : Woman, 62 years old, from Lima. Mother with Parotid cancer. She presented a fracture of the right ankle 15 years ago, 8 years ago a fracture of the 3rd toe of the right foot; In 2008 osteopenia in the lower back and forearm, which irregularly receives calcium carbonate and calcitriol, which it suspended 1 year ago. In 2015, left nephrolithiasis. In January of 2018 calcified nodule in breast, BIRADS 2. In March of 2018 thyroid nodule LTD. Consume 1-10 cigarettes/d from 18 years. She went to rheumatology for polyarthralgias where they find hypercalcemia and is referred to Endocrinology with fatigue, hyporexia and tumors in elbows and ankles. BP: 140/90mmHg. Analytical: corrected serum Ca: 11.8 mg/dl, PO4: 2.4mg/dL, PTH: 234pg/ml, Cr: 0.68mg/dl, Ca urine 24 hours: 324mg/d; TSH: 0.928uUI/ml, FT4: 1.01 ng/dl. Thyroid Eco: Hyperechogenic nodule of 8.6x3.9x6.3mm in RTL, below the lower pole hypoechogenic nodule of 19.7x11x18mm. LTL: Hypoecogenic nodule below the lower pole of 20.1x8x8.3mm. Lower nodule BAAF RTL + needle wash: Parathyroid adenoma with PTH> 2500pg/ml; Tg <0.20. Scintigraphy with SESTAMIBI: hyper-uptake nodules in the lower region of RTL and LTL. Zolendronic Acid and EV Hydration. She was subtotal parathyroidectomy whose pathology reported: lower right parathyroid adenoma and left inferior parathyroid hyperplasia. During the follow-up she receives calcitriol and Calcium Carbonate; she has corrected Ca: 9 mg/dl, Calcium in Urine: 30mg/d, PO4: 4.4mg/d, PTHi: 45.40pg/ml. No manifestations of MEN1.
Discussion : Single adenomas represent up to 80-85% of cases of PHPT, and double adenomas are found in an additional 2-5%. Most adenomas consist of parathyroid major cells. Normally functioning parathyroid glands are not visible on scintigraphy. The combination of different imaging techniques for the study of the parathyroids, has good sensitivity and diagnostic specificity in patients with PHPT.
Conclusion : In the literature, parathyroid adenoma is considered as a unique entity as well as parathyroid hyperplasia, but the coexistence of both conditions in the same patient is rare.
Jose PAZ-IBARRA– ENDOCRINOLOGIST, HOSPITAL NACIONAL EDGARDO REBAGLIATI - UNIVERSIDAD NACIONAL MAYOR DE SAN MARCOS. LIMA - PERU, Lima, Lima, Peru
Karen Salirrosas– ENDOCRINOLOGY RESIDENT, HOSPITAL REBAGLIATI - LIMA - PERU, Lima, Peru
Jorge Merchan– ENDOCRINOLOGY RESIDENT, HOSPITAL REBAGLIATI - LIMA - PERU, Lima, Peru
HOSPITAL NACIONAL EDGARDO REBAGLIATI - UNIVERSIDAD NACIONAL MAYOR DE SAN MARCOS. LIMA - PERU
Lima, Lima, Peru
PERUVIAN ENDOCRINOLOGIST, UNIVERSITY TEACHER, ACTIVE MEMBER OF AACE, AREAS OF INTEREST NEUROENDOCRINOLOGY, THYROID, ENDOCRINOLOGY OF REPRODUCTION AND BONE MINERAL METABOLISM
HOSPITAL REBAGLIATI - LIMA - PERU, Lima, Peru
RESIDENT IN ENDOCRINOLOGY