Parathyroid apoplexy, the explanation of spontaneous remission of primary hyperparathyroidism: a case report

Efremidou, Eleni I; Papageorgiou, Michael; Pavlidou, Evdoxia; Manolas, Konstantinos J; Liratzopoulos, Nikolaos

doi:10.1186/1757-1626-2-6399

Cited by 14 publications

(11 citation statements)

References 12 publications

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“…The residual PTH elevation likely reflected remaining intact hyperfunctional parathyroid tissue. In cases where degeneration is presumably more complete and hyperparathyroidism resolves entirely, others have proposed nonoperative management (15); however, we agree with Efremidou et al (19) that surgical management should be pursued for definitive diagnosis, particularly in the setting of severe calcium elevation and palpable neck mass, as in the case of our patient.…”

Section: Discussionsupporting

confidence: 78%

“…Depending on the amount of functional parathyroid tissue remaining following such an event, it is plausible that partial or complete remission of PHPT may follow. Although rarely observed, spontaneous remission of PHPT is a well-documented phenomenon (14)(15)(16)(17)19). In their meta-analysis, Wootten and Orzeck (14) identified 51 such cases (15), with three additional case reports published since their report (16,17,19).…”

Section: Discussionmentioning

confidence: 99%

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Spontaneous Near-Remission of Hyperparathyroidism after Parathyroid Crisis

Lirov

Kairi

Gauger

2018

AACE Clinical Case Reports

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Objective: To describe an unusual case of primary hyperparathyroidism due to a benign cystic parathyroid adenoma involving parathyroid crisis, profoundly elevated serum calcium and parathyroid hormone levels, and nearremission prior to surgery. Methods: We describe the presentation, evaluation, and treatment of an elderly female with parathyroid crisis due to a benign cystic parathyroid adenoma. Issues related to management of parathyroid crisis, parathyroid cancer, and atypical parathyroid lesions are highlighted. Previously reported cases of spontaneous remission of hyperparathyroidism are briefly reviewed. Results: Our patient was admitted with altered mental status, palpable neck mass, serum calcium level of 22.5 mg/dL, and parathyroid hormone level of 3,131 pg/mL. After immediate stabilization maneuvers, evaluation and treatment proceeded under a presumptive diagnosis of parathyroid cancer. Prior to surgery, parathyroid hormone level had spontaneously reduced by 20-fold. Resection of the parathyroid tumor with en bloc ipsilateral thyroid lobectomy was performed. Pathology demonstrated a benign cystic parathyroid adenoma. Conclusion: To the best of our knowledge, this is the only case of spontaneous near-remission days following admission for parathyroid crisis in which the diagnosis of benign adenoma was confirmed by pathology. This report may therefore contribute to an improved understanding of the natural history of primary hyperparathyroidism associated with atypical parathyroid lesions. The presenting serum calcium and parathyroid hormone levels in this case are among the highest ever reported for primary hyperparathyroidism due to benign adenoma and are at the upper end of values typically observed with parathyroid cancer.

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Section: Discussionsupporting

confidence: 78%

Section: Discussionmentioning

confidence: 99%

Spontaneous Near-Remission of Hyperparathyroidism after Parathyroid Crisis

Lirov

Kairi

Gauger

2018

AACE Clinical Case Reports

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“…The residual PTH elevation likely reflected remaining intact hyperfunctional parathyroid tissue. In cases where degeneration is presumably more complete and hyperparathyroidism resolves entirely, others have proposed non-operative management [16], however, we agree with Efremidou that surgical management should be pursued for definitive diagnosis [18], particularly in the setting of severe calcium elevation and palpable neck mass, as in the case of our patient.…”

Section: Discussionsupporting

confidence: 69%

“…Depending on the amount of functional parathyroid tissue remaining following such an event, it is plausible that partial or complete remission of PHPT may follow. Although rarely observed, spontaneous remission of PHPT is a well-documented phenomenon [15][16][17][18][19]. In their meta-analysis, Wootten et al identified 51 such cases [15,16], with three additional case reports published since their report [17][18][19].…”

Section: Discussionmentioning

confidence: 99%

Spontaneous Near-Remission of Hyperparathyroidism After Parathyroid Crisis

Lirov

Kairi

Gauger

2017

AACE Clinical Case Reports

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ObjectiveTo describe an unusual case of primary hyperparathyroidism due to a benign cystic parathyroid adenoma involving parathyroid crisis, profoundly elevated serum calcium and parathyroid hormone levels, and near-remission prior to surgery. MethodsWe describe the presentation, evaluation, and treatment of an elderly female with parathyroid crisis due to a benign cystic parathyroid adenoma. Issues related to management of parathyroid Abbreviations: PHPT = Primary Hyperparthyroidism; USN = Ultrasounds; PTH = Parathyroid Hormone; CT = Computed Tomography [Scan]. Intraoperative photos showing sequence of mobilization and resection in order of progression A-B. Left thyroid lobe (*), lesion ( †), trachea (Tr), esophagus (Es) Options Oncol. 2012;13:11-23. 4. James BC, Aschebrook-kilfoy B, Cipriani N, Kaplan EL, Angelos P, Grogan RH. The Incidence and Survival of Rare

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“…However, the natural history and biochemical and hormonal changes of primary hyperparathyroidism due to parathyroid adenoma are not well elucidated. Previously reported cases that presented with hypocalcemia resulted from necrosis of the adenoma and incompetence of the remaining parathyroid glands to produce the necessary amounts of PTH or hypercalcemia due to excessive PTH release, followed by finally normocalcemia [3,4].…”

Section: Introductionmentioning

confidence: 99%

A Case of Parathyroid Apoplexy of Primary Hyperparathyroidism Presenting as Auditory Hallucinations Accompanied with Hypocalcemia

2012

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The natural history of primary hyperparathyroidism, due to parathyroid adenoma, is unknown. Furthermore, spontaneous resolution of parathyroid necrosis or hemorrhage is rare and usually asymptomatic. Here, we report a case of parathyroid apoplexy of primary hyperparathyroidism, presenting as auditory hallucinations, accompanied with hypocalcemia. A 39-year-old man who was incidentally diagnosed with primary hyperparathyroidism, and waiting surgery for parathyroidectomy presented to psychiatric service with auditory hallucinations. He developed tetany, while taking psychiatric drugs. On a follow-up investigation, his serum calcium level fell from 11.8 to 5.8 mg/dL. His intact parathyroid hormone level also decreased from 1,017 pg/mL to 71.1 pg/mL. The parathyroid apoplexy was confirmed after a surgical removal of the infarcted adenoma. The auditory hallucinations disappeared, and serum calcium level was returned to within the normal range. (Endocrinol Metab 27:163-168, 2012)

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Parathyroid apoplexy, the explanation of spontaneous remission of primary hyperparathyroidism: a case report

Cited by 14 publications

References 12 publications

Spontaneous Near-Remission of Hyperparathyroidism after Parathyroid Crisis

Spontaneous Near-Remission of Hyperparathyroidism after Parathyroid Crisis

Spontaneous Near-Remission of Hyperparathyroidism After Parathyroid Crisis

A Case of Parathyroid Apoplexy of Primary Hyperparathyroidism Presenting as Auditory Hallucinations Accompanied with Hypocalcemia

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