A rare case of symptomatic hyperparathyroidism in an elderly patient with dual pathology

Abstract

Primary hyperparathyroidism secondary to true sporadic synchronous parathyroid cancer (PTCa) and adenoma (PTa) is rare. This is a case of an 80-year-old female admitted with symptomatic hypercalcaemia, raised serum calcium (Ca) of 3.39 mmol/L and raised parathyroid hormone (PTH) of 44.3 pmol/L. Ultrasonic evaluation of the neck revealed a mass posterior to the right thyroid lobe. Imaging of the left neck was unremarkable. Subsequent sesta-MIBI and single-photon emission computed tomography-computed tomography (SPECT-CT) scanning highlighted conspicuous activity over the right lower neck consistent with the neck ultrasound scan findings. Pre-operatively, PTa was suspected. Intra-operatively, malignancy was suspected due to infiltration of the parathyroid tumour into the thyroid. The right inferior parathyroid and right thyroid gland were resected. Histology confirmed PTCa. Despite surgical treatment, she was found to have persistently high Ca and PTH levels. Further investigation with a repeat sesta-MIBI and SPECT-CT suggested a left inferior parathyroid tumour. Excision of this mass revealed a PTa. Recovery was unremarkable and serum biochemistry returned to normal ranges.

Primary Hyperparathyroidism in Older Adults: A Narrative Review of the Most Recent Literature on Epidemiology, Diagnosis and Management

“…A total of 29 articles met the inclusion criteria (Table 1). The studies break down as follows: 5 studies emphasized the epidemiology [7,[23][24][25][26], 8 studies were available with regard to the clinical manifestations [25,[27][28][29][30][31][32][33], 25 studies addressed the treatments [7,15,[23][24][25][27][28][29][30][31][32][34][35][36][37][38][39][40][41][42][43][44][45][46][47], and 7 considered the post-operative complications [7,25,26,37,44,48,49]. The Joanna Briggs Institute (JBI) critical appraisal tool was used to assess the methodological quality of the included studies and the data are presented in Appendix A (Tables A1-A4).…”

“…Neck cervicotomy and parathyroidectomy were recommended as the preferred safe treatments for elderly patients with PHPT, even for minimal hypercalcemia [15]. Parathyroidectomy was found to be curative in those patients [38,39], with excellent surgical outcomes (80/80 (100.0%) cure in patients ≤50 years compared to 78/80 (97.5%) for patients ≥75 years) (p = 0.150) [25].…”