Unusual Presentation Of Primary Hyperparathyroidism Research Articles

A Treatable but Commonly Missed Etiology;An Unusual Presentation of Primary Hyperparathyroidism as Acute on Chronic Recurrent Pancreatitis- A Case Report

Introduction: Acute pancreatitis is an identified, but uncommon presentation of Primary hyperparathyroidism with prevalence of 3.6%. Hypercalcemia is a rare but known cause of pancreatitis as it leads to premature intra pancreatic activation of protease and destruction of pancreatic tissue leading to pancreatitis. Here we present a case of primary hyperparathyroidism that went undiagnosed for years, and was finally diagnosed after recurrent episodes of pancreatitis of unclear etiology. Case Presentation: A 46-year-old female with history of recurrent pancreatitis presented to the emergency department due to constant epigastric pain for 6 hours associated with nausea and vomiting. Patient reported recurrent episodes of pancreatitis over the past 4 years. Patient was told that etiology of pancreatitis is unclear despite workup. Patient was frustrated that her pancreatitis attacks were usually labeled as alcoholic pancreatitis as she works as a bartender. She strongly states she only drinks alcohol occasionally. She underwent cholecystectomy 2 years ago in attempt to prevent further pancreatitis attacks. Her vital signs were stable. Physical exam was remarkable for epigastric tenderness. CT abdomen and pelvis with contrast showed chronic pancreatitis, pseudocyst and free fluid in the pancreatic bed characteristic of acute pancreatitis. Abdominal US showed post cholecystectomy changes, with no biliary dilatation or stones. Initial labs showed: lipase 2001 U/L, Alcohol level < 10 mmol/L, Calcium 11.5 mg/dl, ionized calcium 4.9 mg/dl, phosphate 2.7 mg/dl, and Triglycerides 52 mg/dl. Subsequently parathyroid hormone was checked and was 116.8 pg/ml. Vitamin D was normal. NM parathyroid scan showed increased tracer activity demonstrating parathyroid adenoma. Patient was given IVF and supportive treatment and her symptoms improved. Endocrinology recommended parathyroidectomy. Patient elected to be discharged and undergoes parathyroidectomy outpatient. Discusion: In this case we emphasize the importance of considering PHPT in acute pancreatitis of unclear etiology especially when Calcium level is elevated. PHPT was missed as a treatable etiology despite mildly elevated calcium level in prior hospitalizations. It is reported that pancreatitis is frequently associated with hypocalcemia with prevalence of 15–88%. Moreover, hypocalcemia is a component of Ranson’s scoring system for severity of pancreatitis. This is explained by precipitation of calcium soaps, hypoalbuminemia and increased calcitonin secondary to glucagon release. PTHT induced pancreatitis management has the same general principles of supportive management. All these patients, once stable, should undergo parathyroidectomy for definitive treatment. Data suggests nearly 100% improvement in pancreatitis symptoms and prevention of recurrent pancreatitis episodes after the cure of PHPT.

Extensive aortic mediacalcosis: an unusual presentation of primary hyperparathyroidism

Extensive aortic mediacalcosis: an unusual presentation of primary hyperparathyroidism

Hypokalemic periodic paralysis: an unusual presentation of primary hyperparathyroidism

Primary hyperparathyroidism is an endocrine condition characterized by hyper secretion of parathyroid hormone (PTH). It has a wide varied clinical presentation from mild nonspecific symptoms to classical disease. We herein report two cases of primary hyperparathyroidism who were presented as hypokalemic periodic paralysis. The aim of this case report is to highlight this unusual presentation of primary hyperparathyroidism. Patients presenting with hypokalemic periodic paralysis should be evaluated for the possibility of primary hyperparathyroidism. Surgeons should be aware of this unusual presentation of primary hyperparathyroidism thereby it can be detected earlier, and prompt treatment can be offered before the disease progresses.

Unusual Presentation of Primary Hyperparathyroidism: A Rare Case Report

ABSTRACT Aim The aim of this case report is to highlight an exceptional presentation of primary hyperparathyroidism. Background Asymptomatic maternal hyperparathyroidism manifesting in the neonate as hypocalcemic convulsions is exceedingly rare. Case report: Primary hyperparathyroidism has got a varied presentations. We present a case report of neonatal hypocalcemic convulsions secondary to asymptomatic maternal hyperparathyroidism. Here, the challenge in diagnosing this condition and management will be discussed in the context of available literature. Conclusion In the event of nonfebrile seizures in the neonate due to hypocalcemia, the mother has to be evaluated for primary hyperparathyroidism. Clinical significance: Physicians’ awareness of this unique manifestation of primary hyperparathyroidism is essential for the appropriate management of both the mother and the neonate. Timely identification and treatment of this condition will prevent complications in both. How to cite this article Teja VS, Ramakrishnan R. Unusual Presentation of Primary Hyperparathyroidism: A Rare Case Report. World J Endoc Surg 2017;9(1):13-15.

Unusual presentation of primary hyperparathyroidism with coexisted thyroid carcinoma

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Seizure and Profound Hypokalemia: Unusual Presentation of Primary Hyperparathyroidism

Abstract: A 68-year-old man was admitted because of tonic–clonic convulsion. He had been receiving 200 mg itraconazole for 10 days. He had hypokalaemia (2.2 mEq/l), hypercalcaemia (Ca corr 11.0 mg/dl) and elevated serum parathyroid hormone (PTH, 95 pg/ml). Ultrasound examination of the neck revealed a low echoic tumour. Cessation of itraconazole and fluid supplementation eradicated clinical symptoms and profound hypokalaemia, but serum potassium remained low normal (3.4 mEq/l) and the mild hypercalcaemia and elevated PTH were unchanged. To conclude, a small amount of itraconazole (200 mg) precipitated profound hypokalaemia and seizure in a patient with mild hyperparathyroidism and low normal serum potassium.

An Unusual Presentation of Primary Hyperparathyroidism: Pathological Fracture

Primary hyperparathyroidism revealed by a pathological fracture is very uncommon. We present a case of a 54-year-old female patient who was admitted with fracture of her right femur. She underwent closed intramedullary reconstruction nailing with bipolar locking. The pathological findings confirmed the diagnosis of primary hyperparathyroidism with brown tumor. Further tests showed increased both calcium level and PTH level. A parathyroidectomy was performed. She made an uneventful recovery and was discharged to home.

“An exophytic mandibular brown tumor”: an unusual presentation of primary hyperparathyroidism

A case of 35-year-old male patient with previously undiagnosed primary hyperparathyroidism who presented with an atypical exophytic mandibular swelling is reported. The aim is to alert the clinicians to include this entity although extremely rare, in the differential diagnosis of swellings in the maxillofacial region and to highlight another remarkable aspect in the multitude of presentations associated with primary hyperparathyroidism especially in the setting of normocalcemia.

Brown Tumor of the Ulna and Radius: An Unusual Presentation of Primary Hyperparathyroidism

Brown tumors are erosive bony lesions caused by chronic excessive secretion of parathyroid hormone. Since the introduction of routine calcium measurement, the diagnosis of hyperparathyroidism has usually been made in asymptomatic patients and as a result, brown tumors are rarely observed as an initial manifestation of hyperparathyroidism. We report the case of a 70-year-old woman who presented with right wrist pain. A roentgenogram showed erosive bone tumors of the ulna and radius, which were mistaken for primary or metastatic bone tumors. Extensive workups were performed to determine the cause(s); however, these lesions were finally diagnosed as brown tumors associated with primary hyperparathyroidism due to a parathyroid adenoma. This case illustrates the diagnostic pitfall in patients who present with skeletal manifestations of hyperparathyroidism and the need for vigilance and a high level of suspicion by physicians. (J Korean Endocr Soc 23:347~351, 2008)

An unusual presentation of primary hyperparathyroidism: Severe hypercalcemia and multiple brown tumors

Primary hyperparathyroidism is common, particularly in postmenopausal women. Since the introduction of routine automated serum calcium assays and the development of assays for intact 1–84 parathyroid hormone, the diagnosis is usually made fortuitously in asymptomatic patients or during evaluation for osteoporosis. As a result, many physicians have no experience with the clinical manifestations. Here, we describe the case of a 70-year-old man with bone pain, multiple brown tumors, and severe hypercalcemia (4 mmol/L). The diagnostic pitfalls raised by these symptoms are illustrated.

Unusual Presentation of Primary Hyperparathyroidism with Osteoporosis, Hypercalcemia, and Normal Parathyroid Hormone Level

We report the case of a woman with osteoporosis, chronic hypercalcemia, and normal levels of parathyroid hormone (PTH). Surgical exploration revealed hyperplasia of the parathyroid glands. Hypercalcemia was corrected immediately by surgery, and this was followed by a dramatic improvement in bone mineral density. This case represents a rarely reported presentation of primary hyperparathyroidism with an atypical laboratory finding.

Unusual Presentation of Primary Hyperparathyroidism with Osteoporosis, Hypercalcemia, and Normal Parathyroid Hormone Level

We report the case of a woman with osteoporosis, chronic hypercalcemia, and normal levels of parathyroid hormone (PTH). Surgical exploration revealed hyperplasia of the parathyroid glands. Hypercalcemia was corrected immediately by surgery, and this was followed by a dramatic improvement in bone mineral density. This case represents a rarely reported presentation of primary hyperparathyroidism with an atypical laboratory finding.