MyMedR

Fulltext Osseous haemophilic pseudotumour and concurrent primary hyperparathyroidism: a diagnostic conundrum

Low SF, Sridharan R, Ngiu CS, Haflah NH

BMJ Case Rep, 2014;2014.

PMID: 24729114 DOI: 10.1136/bcr-2013-203282

Pseudotumours are rare, occurring in 1-2% of severe haemophiliacs. Osseous locations are far less frequent than soft tissue location. We report a case of a 43-year-old man with haemophilia A, who presented with a gradually enlarging left thigh mass for 8 months. There were no constitutional symptoms. Plain radiograph showed an expansile lytic lesion with 'soap-bubble' appearance arising from the left femur diaphysis. On MRI, it appeared as a non-enhancing, multilobulated lesion expanding the medullary and subperiosteal spaces. The mass exhibited concentric ring sign with heterogeneous intermediate signal intensity in the core lesion, reflective of chronic haematoma with blood degradation products of different stages. A diagnosis of haemophilic pseudotumour was made. Hypercalcaemia, however, raised a diagnostic dilemma as bone malignancy needed to be considered. An open excisional biopsy and subsequent amputation confirmed the diagnosis of osseous haemophilic pseudotumour. Nuclear medicine study later revealed a concurrent parathyroid adenoma.

Matched MeSH terms: Hyperparathyroidism, Primary/complications*

Metabolic Superscan on 18 F-FDG PET/CT in a Patient With Secondary Hyperparathyroidism

Mohd Rohani MF, Bujang NL, Rosdi AH, Amir Hassan SZ

Clin Nucl Med, 2024 Jan 01;49(1):e19-e21.

PMID: 37883221 DOI: 10.1097/RLU.0000000000004941

Superscan on PET/CT has been reported in the literature and mainly involved metastatic diseases. We report an uncommon case of a metabolic superscan on 18 F-FDG PET/CT in a 56-year-old man with end-stage renal disease on hemodialysis who presented with secondary hyperparathyroidism. Parathyroid scintigraphy showed 2 lesions posteroinferior to both thyroid lobes, suggestive of parathyroid adenoma/hyperplasia. FDG PET/CT performed to assess for pulmonary nodules revealed diffuse FDG hypermetabolism involving the visualized skull, mandible, spine, sternum, ribs, and appendicular skeleton without corresponding CT lesion with no urinary radiotracer excretion, consistent with metabolic superscan secondary to renal osteodystrophy.

Matched MeSH terms: Hyperparathyroidism, Primary*

Hypercalcaemic crisis: immediate parathyroidectomy and intraoperative intravenous calcium infusion improves outcome

Harjit K, Zanariah H, Hisham AN

Asian J Surg, 2007 Jul;30(3):173-7.

PMID: 17638635

The hypercalcaemic crisis of hyperparathyroidism is an endocrine emergency that is invariably fatal if untreated. Despite emergency parathyroidectomies to treat hypercalcaemic crisis, mortality rates remain high. The rapid decline of serum calcium levels after removal of an adenoma and its adverse effect on the heart contributes to the development of postoperative complications and death. The cornerstone of surgical treatment for hypercalcaemic crisis is to begin infusion of high doses of calcium immediately after successful removal of parathyroid adenomas to allow gradual and well-controlled decline of serum calcium to avoid fatal myocardial complications.

Matched MeSH terms: Hyperparathyroidism, Primary/complications; Hyperparathyroidism, Primary/therapy

Effect of vitamin D replacement in primary hyperparathyroidism with concurrent vitamin D deficiency: a systematic review and meta-analysis

Loh HH, Lim LL, Yee A, Loh HS, Vethakkan SR

Minerva Endocrinol., 2019 Jun;44(2):221-231.

PMID: 28294593 DOI: 10.23736/S0391-1977.17.02584-6

INTRODUCTION: We conducted a meta-analysis to assess the effects of vitamin D replacement on biochemical and skeletal parameters in subjects with mild primary hyperparathyroidism (PHPT) and coexistent vitamin D deficiency.

EVIDENCE ACQUISITION: A systematic search of all English-language medical literature published from 1980 till May 2016 using PubMed, Embase and Ovid was performed. Nine observational studies were evaluated after fulfilling the inclusion and exclusion criteria.

EVIDENCE SYNTHESIS: A total of 547 patients were examined. All studies used vitamin D2/D3 or calcifediol (25-hydroxyvitamin D3), There was significant improvement of serum 25(OH)D with unchanged serum iPTH level after vitamin D replacement, with pooled d+: 3.10 (95% CI 2.25 to 3.95), P<0.01 and pooled d+: 0.82 (95% CI -0.35 to 1.98), P=0.16 respectively. There was neither worsening of the pre-existing hypercalcemia (pooled d+: -0.27 [95% CI -1.09 to 0.64, P=0.56]) nor hypercalciuria (pooled d+: 3.64 [95% CI -0.55 to 7.83, P=0.09]). Two studies assessed in this meta-analysis reported unchanged bone density with vitamin D replacement.

CONCLUSIONS: Vitamin D replacement in subjects with mild PHPT and coexistent vitamin D deficiency improved serum 25(OH)D level without worsening of pre-existing hypercalcemia or hypercalciuria. Well-designed multicenter randomized controlled trials examining pre- and postoperative outcomes of vitamin D therapy in patients with different severities of PHPT and vitamin D inadequacy are warranted to elucidate the most appropriate vitamin D treatment protocol and determine the long-term safety concerns.

Matched MeSH terms: Hyperparathyroidism, Primary/complications*; Hyperparathyroidism, Primary/drug therapy*

Fulltext Bilateral Genu Valgum in an Adolescent with Primary Hyperparathyroidism: A Case Report and Review of Literature

Lee SP, Chai ST, Loh LT, Ali NM

J ASEAN Fed Endocr Soc, 2020;35(2):220-223.

PMID: 33442194 DOI: 10.15605/jafes.035.02.07

Primary hyperparathyroidism in children and adolescents is rare and often symptomatic at presentation. A 15-year-old bo presented with bilateral genu valgum for two years. Biochemical results were consistent with primary hyperparathyroidism Calcium levels normalized two months after removal of a left inferior parathyroid adenoma.

Matched MeSH terms: Hyperparathyroidism, Primary

Fulltext Communicating Hydrocephalus in a Case of Long-Term Primary Hyperparathyroidism

Ooi CP, Mustafa N, Kew TY

J ASEAN Fed Endocr Soc, 2018;33(1):49-52.

PMID: 33442110 DOI: 10.15605/jafes.033.01.08

We present the rare case of a 47-year-old woman with protracted primary hyperparathyroidism complicated by communicating hydrocephalus and cerebellar tonsillar herniation secondary to calvarial thickening. The parathyroid glands remained elusive, despite the use of advanced preoperative imaging modalities and three neck explorations. The serum calcium was optimally controlled with cinacalcet and alfacalcidol. Awareness of this rare complication is essential for early diagnosis and prompt intervention to prevent fatal posterior brain herniation.

Matched MeSH terms: Hyperparathyroidism, Primary

Large retrosternal parathyroid carcinoma with primary hyperparathyroidism

Tan GC, Shiran MS, Swaminathan M, Phang KS, Rohaizak M

Asian J Surg, 2007 Oct;30(4):286-9.

PMID: 17962134

Parathyroid carcinoma is an uncommon cause of parathyroid hormone (PTH)-dependent hypercalcaemia, accounting for less than 1% of all cases of hyperparathyroidism. Parathyroid carcinoma is an indolent tumour with rather low malignant potential. Consideration of parathyroid carcinoma in the differential diagnosis of hypercalcaemic disorders is important because the morbidity and mortality are substantial and the best prognosis is associated with early recognition and surgical resection. Clinical indicators favouring parathyroid carcinoma over benign disease include markedly raised serum calcium levels, PTH and alkaline phosphatase. A palpable neck mass with both kidney and skeletal manifestations also give a high index of suspicion of parathyroid carcinoma. Histopathology alone is not sufficient to diagnose parathyroid cancer; it has to be correlated with the clinical findings. The initial and most effective treatment for parathyroid carcinoma is complete resection of the primary lesion, and repeated operations for recurrence are useful. The prognosis of parathyroid carcinomas is quite variable; 5-year survival rates vary from 40% to 86%, while the 10-year survival rate is approximately 49%. We report a case of parathyroid carcinoma occurring in a 55-year-old woman who presented with bone pain and hypercalcaemia.

Matched MeSH terms: Hyperparathyroidism, Primary/etiology*

Primary hyperparathyroidism: a rare cause of genu valgus in adolescence

Ratnasingam J, Tan AT, Vethakkan SR, Paramasivam SS, Ibrahim L, Lim LL, et al.

J Clin Endocrinol Metab, 2013 Mar;98(3):869-70.

PMID: 23337722 DOI: 10.1210/jc.2012-3839

Matched MeSH terms: Hyperparathyroidism, Primary/complications*

Fulltext Primary hyperparathyroidism with hungry bone syndrome - A Case Report

Norazmi, K., Khairul, A.J.

International Medical Journal Malaysia, 2007;6(2):1-7.

MyJurnal

Primary hyperparathyroidism with severe bone disease as a result of excessive parathyroid hormone ( PTH ) release and severe hypercalcaemia can lead to 'hungry bone syndrome' (HBS) post operatively. This is due to sudden cessation of PTH and drop in serum calcium. We reported a case a young man with primary hyperparathyriodism due to a single parathyroid adenoma with severe bone disease and post operatively developed hungry bone syndrome.

Matched MeSH terms: Hyperparathyroidism, Primary

Fulltext Primary hyperparathyroidism with vitamin D deficiency in third trimester of pregnancy

Tong, Chin Voon, Mohamad Rafie Md Kaslan

International e-Journal of Science, Medicine & Education, 2015;9(3):47-51.

MyJurnal

In pregnancy, the diagnosis of primary hyperparathyroidism (PHP) may be delayed due to physiological changes that occur during this period. The maternal related complications of PHP during pregnancy has been reported to be as high as 67%, whilst fetal complications up to 80% of cases.1 The therapeutic gold standard and definitive treatment for PHP in pregnancy is minimally invasive parathyroidectomy in the second trimester. We report a case of a 22-year old primidgravida who underwent parathyroidectomy in the third trimester of her pregnancy for PHP with persistent hypercalcemia. She was also found to have Vitamin D deficiency which probably led to secondary hyperparathyroidism and made her hypercalcemia more apparent during pregnancy

Matched MeSH terms: Hyperparathyroidism, Primary

Fulltext An interesting case of systemic lupus erythematosus presenting with hypercalcemia: A diagnostic dilemma

Abdul Gafor AH, Cader RA, Das S, Masir N, Wahid FA

Am J Case Rep, 2013;14:1-3.

PMID: 23569551 DOI: 10.12659/AJCR.883849

BACKGROUND: Hypercalcemia is common in primary hyperparathyroidism malignancies and even in tuberculosis. Interestingly, systemic lupus erythematosus (SLE) rarely presents with hypercalcemia.
CASE REPORT: We describe an interesting case of SLE in a patient who was otherwise thought to have either tuberculosis or a malignancy. The patient initially presented with feeling unwell, with generalized lymphadenopathy, bilateral pleural effusion, and bilateral corneal calcium deposits secondary to severe hypercalcemia. The diagnosis of SLE was made based on positivity of antinuclear antibodies (ANA) and anti-dsDNA, the presence of serositis, lymphadenopathy, autoimmune hemolytic anemia, and constitutional symptoms. She was treated with steroids, with tremendous improvement in her general well-being, resolution of lymphadenopathy and pleural effusion, and normalization of her hemoglobin and serum calcium. The atypical presentation of SLE with hypercalcemia with pleural effusion is discussed.
CONCLUSIONS: SLE should be one of the differential diagnoses in patients presenting with severe hypercalcemia.
KEYWORDS: atypical presentation; hypercalcemia; systemic lupus erythematosus

Matched MeSH terms: Hyperparathyroidism, Primary

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