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A patient with persistent primary hyperparathyroidism due to a second ectopic adenoma

Nature Clinical Practice Endocrinology & Metabolism volume 3, pages 311–315 (2007)Cite this article

Abstract

Background A 33-year-old woman presented with recurrent renal stones and malaise to her primary-care physician. Laboratory investigations revealed the patient had hypercalcemia and an elevated serum parathyroid hormone concentration. A diagnosis of primary hyperparathyroidism was established and the patient was referred for parathyroidectomy. At neck exploration, three parathyroid glands were visualized, one of which was enlarged and subsequently removed. The patient's serum calcium and parathyroid hormone levels decreased postoperatively but did not normalize, and her symptoms persisted. Planar 99mTc–sestamibi and ultrasound scans failed to provide conclusive localization for another enlarged parathyroid gland. The patient was referred to our Endocrinology Unit for further investigations and management.

Investigations Laboratory investigations, ultrasound of the kidneys, BMD measurements, selective venous sampling for parathyroid hormone, and 99mTc–sestamibi single photon emission CT imaging.

Diagnosis Persistent hyperparathyroidism due to an ectopically located parathyroid adenoma.

Management At further neck exploration, a 1.5 cm by 0.7 cm by 0.5 cm ectopic parathyroid adenoma was excised from the site indicated by the localization studies. No further exploration was attempted after intraoperative parathyroid hormone levels fell by 70%. Serum calcium levels and 24 h urine excretion of calcium rapidly normalized and all of the patient's symptoms completely disappeared within a few weeks of surgery.

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Figure 1: An anterior view of the patient's 99mTc–sestamibi SPECT (single photon emission CT) image

References

  1. Proceedings of the National Institute of Diabetes and Digestive and Kidney Diseases Workshop (2002) Asymptomatic primary hyperparathyroidism: a perspective for the 21st century. Bethesda, Maryland, USA. April 8–9, 2002. J Bone Miner Res 17: N1–N162

  2. AACE/AAES Task Force on Primary Hyperparathyroidism. (2005) The American Association of Clinical Endocrinologists and the American Association of Endocrine Surgeons position statement on the diagnosis and management of primary hyperparathyroidism. Endocr Pract 11: 49–54

  3. Bilezikian JP et al. (2002) Summary statement from a workshop on asymptomatic primary hyperparathyroidism: a perspective for the 21st century. J Clin Endocrinol Metab 87: 5353–5361

    Article  CAS  PubMed  Google Scholar 

  4. Marx SJ and Simonds WF (2005) Hereditary hormone excess: genes, molecular pathways, and syndromes. Endocr Rev 26: 615–661

    Article  CAS  PubMed  Google Scholar 

  5. Rao DS et al. (2004) Randomized controlled clinical trial of surgery versus no surgery in patients with mild asymptomatic primary hyperparathyroidism. J Clin Endocrinol Metab 89: 5415–5422

    Article  CAS  PubMed  Google Scholar 

  6. Talpos GB et al. (2000) Randomized trial of parathyroidectomy in mild primary hyperparathyroidism: patient description and effects of the SF-36 health survey. Surgery 128: 1013–1021

    Article  CAS  PubMed  Google Scholar 

  7. Marcus R (2002) The role of estrogens and related compounds in the management of primary hyperparathyroidism. J Bone Miner Res 17 (Suppl 2): N146–N149

    CAS  PubMed  Google Scholar 

  8. Khan AA et al. (2004) Alendronate in primary hyperparathyroidism: a double-blind randomized, placebo-controlled trial. J Clin Endocrinol Metab 89: 3319–3325

    Article  CAS  PubMed  Google Scholar 

  9. Peacock M et al. (2005) Cinacalcet hydrochloride maintains long-term normocalcemia in patients with primary hyperparathyroidism. J Clin Endocrinol Metab 90: 135–141

    Article  CAS  PubMed  Google Scholar 

  10. Silverberg SJ et al. (1999) A 10-year prospective study of primary hyperparathyroidism with or without parathyroid surgery. N Engl J Med 341: 1249–1255

    Article  CAS  PubMed  Google Scholar 

  11. Moka D et al. (2000) Technetium 99m-MIBI-SPECT: a highly sensitive diagnostic tool for localization of parathyroid adenomas. Surgery 128: 29–35

    Article  CAS  PubMed  Google Scholar 

  12. Jones JJ (2002) Accuracy of selective venous sampling for intact parathyroid hormone in difficult patients with recurrent or persistent hyperparathyroidism. Surgery 132: 944–951

    Article  PubMed  Google Scholar 

  13. Nilsen FS et al. (2006) Does rapid intraoperative parathyroid hormone analysis predict cure in patients undergoing surgery for primary hyperparathyroidism? A prospective study. Scand J Surg 95: 28–32

    Article  CAS  PubMed  Google Scholar 

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Author notes

  1. Department of Endocrinology & Metabolic Diseases, Leiden University Medical Center, Albinusdreef 2333 ZA, Leiden, The Netherlands n.a.t.hamdy@lumc.nl

Authors and Affiliations

  1. NAT Hamdy is an Associate Professor of Medicine and Head of the Clinic Section of the Department of Endocrinology & Metabolic Diseases at the Leiden University Medical Center, Leiden, The Netherlands.,

    Neveen AT Hamdy

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  1. Neveen AT Hamdy
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Hamdy, N. A patient with persistent primary hyperparathyroidism due to a second ectopic adenoma. Nat Rev Endocrinol 3, 311–315 (2007). https://doi.org/10.1038/ncpendmet0448

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