Primary hyperparathyroidism characterized by diffuse homogeneous metastatic pulmonary calcification

Abstract

Rationale:Primary hyperparathyroidism (PHPTI) with respiratory tract symptom is extremely rare. It is caused by autonomic oversecretion of parathyroid hormone (PTH) owing to parathyroid adenoma, hyperplasia, or tumor. The diagnosis of PHPTI often needs to be made based on medical history, clinical manifestation, laboratory tests, and imaging examination. Moreover, no study has reported PHPTI with diffuse metastatic pulmonary calcification (MPC) as the characteristic.Patient concerns:A 49-year-old female from Zhejiang, China, had a fever of unknown origin, cough with white crude sputum, and asthma after activity for 1 month.Diagnosis:The computed tomography (CT) examination revealed a homogeneous and diffuse high-density shadow in both lungs. The pathologic examination with CT-guided lung biopsy (left lung puncture) suggested interstitial inflammation of the lung tissue, combined with fibroblast proliferation as well as calcification. B-ultrasonography identified a lump in the right parathyroid gland, with a size of 4.1 × 1.7 × 1.9 cm3. Color Doppler sonography indicated rich blood flow inside the lump. Whole-body bone emission computed tomography imaging showed the enhancement of bone metabolism in bilateral lower extremities and a diffuse enhancement of radioactive distribution in both lungs. 99mTc-methoxyisobutyl isonitrile imaging suggested significantly increased MIBI uptake in the right superior pole of the thyroid gland and indicated adenoma of the right superior parathyroid. The diagnosis of PHPTI was confirmed by postoperative pathology.Interventions:The patient received a resection of the right parathyroid adenoma.Outcomes:After surgery, the symptom such as fever, coughing, and white crude sputum were significantly alleviated.Lessons:This novel case reported the case of a patient with PHPTI having respiratory tract infection as the 1st symptom and diffuse MPC as the symptom characteristic PHPTI, the findings of this case study might improve the recognition of PHPTI on diffuse pulmonary calcification for clinical doctors.

Metastatic microcalcification in the lungs and stomach due to hyperparathyroidism: A case report

“… 9 To our knowledge, there have been few reports of patients with a parathyroid adenoma who presented with symptoms suggesting metastatic microcalcification in lungs and stomach. 4 – 7 …”

“… 10 – 15 Data from the few reports of metastatic microcalcification due to parathyroid adenoma have shown that the deposition tends to occur in the stomach, kidneys, heart and lungs, with the pulmonary system being particularly susceptible. 4 – 7 , 16 The pathogenic mechanisms of metastatic microcalcification have yet to be elucidated but most reports suggest that hypercalcaemia and a local alkaline environment may contribute to the condition. 17 In the case presented here, the patient had hypercalcaemia due to PHPT and impaired kidney function, which would have resulted in a decrease in the excretion of excess calcium.…”

“…From the few reports of metastatic microcalcification in the lungs due to PHPT, it appears that the patients tend to present with cough and dyspnoea. 4 – 7 , However, respiratory distress and fulminant respiratory failure have also been reported. 5 – 7 , 16 , 19 Our patient had dry cough, which may have been related to microcalcification in the alveolar septa.…”

“…Clinical symptoms of PHPT affecting the respiratory system are rare and often caused by metastatic microcalcification. 4 – 7 Diagnosis is challenging because it may be misdiagnosed as pulmonary oedema and/or interstitial lung disease. We present here a case of PHPT with diffuse metastatic microcalcification in the lungs and stomach detected by single-photon emission tomography/computed tomography (SPECT/CT) using technetium-99m-diphosphonate ( 99m Tc-MDP).…”

Primary hyperparathyroidism characterized by diffuse homogeneous metastatic pulmonary calcification: A case report: Erratum

“…In the article, “Primary hyperparathyroidism characterized by diffuse homogeneous metastatic pulmonary calcification: A case report”, [1] which appears in Volume 97, Issue 44 of Medicine , the authors would like to note a change in author order. The author order should be Yuzhu Jia, Lihua Wang, Guangzhao Yang, Guoqun Mao, Yougen Cheng, Yulin Cao.…”