GIANT PARATHYROID HYPERPLASIA AS A CAUSE OF SEVERELY SYMPTOMATIC PRIMARY HYPERPARATHYROIDISM

AUTHORS:
M. Sánchez-Rodríguez (Madrid, Spain) , L. Zarain Obrador (Madrid, Spain) , I. Amunategui Prats (Madrid, Spain) , J.L. Escat Cortés (Madrid, Spain) , J. Jiménez Ruiz (Madrid, Spain) , E. Mercader Cidoncha (Madrid, Spain)
Background:
The usual clinical presentation of primary hyperparathyroidism (pHPT) in our daily practice is asymptomatic hypercalcemia due to uniglandular disease (80%). We aim to present a rare case of severe symptomatic pHPT caused by a giant hyperplasia of the parathyroid glands.
Methods:
Clinical case of a Peruvian 83-year-old woman with severe osteoporosis (BMD TScore -4 and multiple vertebral fractures) and recurrent renoureteral colic, who was admitted for severe hypercalcemia with corrected calcium (cCa) levels of 13.5 mg/dL. The diagnostic study revealed parathormone (PTH) levels of 1009 ng/L, hypophosphatemia and renal failure. Localization study found an increased size of the 4 parathyroid glands in neck ultrasound (larger glandular size of 45mm) with increased uptake in SPECT-CT. A diagnosis of hypercalcemic pHPT without conclusive localization study was made and the patient was scheduled for bilateral neck exploration.
Results:
Increased size of the 4 parathyroid glands were found so subtotal parathyroidectomy was performed, checking vascularization of the glandular remnant with the ICG test. The patient was discharged at 7th postoperative day without complications. Pathological report revealed glandular hyperplasia with heavy weights up to 15g. At 6th postoperative month, the patient reached normocalcemia with cCa 9.2 mg/dL and PTH 136 ng/L.
Conclusions:
Cases of severe hypercalcemia could exist as a presentation of primary hyperparathyroidism caused by multiglandular disease.