Acute airway compromise due to parathyroid tumour apoplexy: an exceptionally rare and potentially life-threatening presentation

Abstract

BackgroundSpontaneous haemorrhage into a parathyroid adenoma is a rare and potentially life-threatening presentation.Case presentationWe report the case of a 45 year old female recently diagnosed with primary hyperparathyroidism who presented with chest discomfort and acute airway compromise due to spontaneous extracapsular haemorrhage into a parathyroid adenoma. Computed tomography (CT) imaging showed a hypopharyngeal haematoma extending 10 cm into the superior mediastinum. Surgical decompression of the cyst followed by enbloc resection of the parathyroid tumour was performed after elective intubation. Calcium and parathyroid hormone (PTH) levels had fallen prior to surgery and remain normal post-operatively.ConclusionSpontaneous parathyroid haemorrhage should be considered in any patient with unexplained spontaneous cervical haemorrhage, particularly if there is a history of hyperparathyroidism. Initial evaluation of such patients should include serum calcium and PTH as well as imaging.

Parathyroid Apoplexy Following Cinacalcet Treatment in Primary Hyperparathyroidism

“…We herein report a case of parathyroid adenoma apoplexy following cinacalcet treatment in a patient with primary hyperparathyroidism. Although spontaneous cases of parathyroid apoplexy have been previously described in primary hyperparathyroidism (7–9), this is the first case observed in association with cinacalcet treatment.…”

“…Spontaneous parathyroid apoplexy occurs rarely in primary hyperparathyroidism and features heterogeneous manifestations such as cervical pain, neck mass and compression symptoms, hematoma or ecchymosis, hypercalcemic crisis due to acute PTH release, and hypocalcemia with tetany or convulsions due to auto-parathyroidectomy (8). Asymptomatic cases and potentially life-threatening manifestations are also described (9). The pathogenesis of parathyroid apoplexy is considered secondary to an imbalance between the growth of the adenoma and its blood supply.…”

Atypical presentations of parathyroid gland pathology: A pictorial review

“…Patients can present acutely with airway compromise and sudden neck swelling as well as neck and/or chest bruising, dysphagia and dysphonia (the result of compression on the oesophagus, vagus or recurrent laryngeal nerve). Serum biochemistry can be very variable with patients presenting in hypercalcaemic crises, in eucalcaemic or hypocalcaemic states; the latter two are thought to be the consequence of parathyroid gland infarction [21]. Whilst spontaneous gland infarction can lead to remission of primary hyperparathyroidism, this does not always equate to an auto-parathyroidectomy as biochemical evidence of recurrent disease have been reported, likely secondary to remnant parathyroid tissue [20].…”

Spontaneous massive extracapsular haemorrhage in a parathyroid carcinoma

“…After performing a literature search of PubMed and Google Scholar databases, thirty cases of spontaneous haemorrhage in parathyroid adenomas were identified, with only one previous report of spontaneous haemorrhage in a parathyroid carcinoma . Our case report was assembled following CARE case report guidelines, with written informed consent obtained from the patient and the Institutional Review Board according to the Helsinki Declaration of 1983.…”

“…An added difficulty is distinguishing between thyroid and parathyroid involvement, even with available CT and US findings. Neck haematomas associated with parathyroid carcinomas are extremely rare and should be considered when the patient has dysphagia, cervical or thoraco‐cervical ecchymoses and hypercalcaemia, alongside a firm parathyroid mass …”