IJCRR - 6(1), January, 2014
PRIMARY HYPERPARATHYROIDISM DUE TO BILATERAL PARATHYROID ADENOMA - A CLINICAL CASE REPORT
Author: Mousumi Mukhopadhyay, Sharmistha Chattopadhay, Sanghamitra Chakraborty, Swati Bhattacharyya, Soumika Biswas
Primary hyperparathyroidism is known by inappropriate secretion of parathyroid hormone that results in hypercalcaemia. The most common cause of primary hyperparathyroidism is solitary adenoma of the parathyroid followed by multiple adenoma, parathyroid hyperplasia and carcinoma, in that order. This paper describes the case of a fifty two year old man who presented with pain and swelling over multiple joints on trivial trauma( right elbow, right knee and left shoulder) against a backdrop of diverse symptoms like anorexia, nausea, weight loss, etc. of insidious onset over the past ten months. Detailed laboratory workup revealed hypercalcaemia (measured on more than one occasion) with concomitant hypophosphatemia, hypercalciuria, raised serum intact parathyroid hormone and elevated skeletal isoenzyme of serum alkaline phospatase. The causes of non parathyroid hypercalcaemia in the differential diagnosis were excluded by the serum 25 hydroxy vitamin D estimation which was found to be in the upper normal range. Finally, the diagnosis was clinched by the serum iPTH assay which is the most sensitive and specific test for parathyroid function. The histological picture was consistent with parathyroid adenoma. Subsequently, surgical resection of the parathyroid achieved normocalcaemia and the patient was discharged with bisphosphonates and calcium supplements.
Keywords: Primary Hyperparathyroidism, Adenoma, Hypercalcaemia
Mousumi Mukhopadhyay, Sharmistha Chattopadhay, Sanghamitra Chakraborty, Swati Bhattacharyya, Soumika Biswas. PRIMARY HYPERPARATHYROIDISM DUE TO BILATERAL PARATHYROID ADENOMA - A CLINICAL CASE REPORT International Journal of Current Research and Review. 6(1), January, 95-100
1. Bringhurst FR, Demay MB, Krokenberg HM : Hormones and Disorders of Mineral Metabolism : William Textbook of Endocrinology, Melmeds, Polonosky KS, Larsen PR, Krokenberg HM (eds) , 2012, 12ed, 1260 Philadelphia
2. Deshmukh, R. G.; Alsagoff, S. A. L.; Krishnan, S.; Dhillon, K. S.; Khir, A. S. M. (1998). "Primary hyperparathyroidism presenting with pathological fracture". Journal of the Royal College of Surgeons of Edinburgh 43 (6): 424–427.
3. Bilezikian, John P.; Silverberg, Shonni J. (2002). "Primary hyperparathyroidism: Epidemiology and clinical consequences". Clinical Reviews in Bone and Mineral Metabolism 1 (1): 25–34.
4. Bolland, M. J.; Grey, A. B.; Gamble, G. D.; Reid, I. R. (2004). "Association between Primary Hyperparathyroidism and Increased Body Weight: A Meta-Analysis". Journal of Clinical Endocrinology and Metabolism 90 (3): 1525.
5. "Endocrine Pathology". Retrieved 2009-05- 08.
6. Bile Zikian JP. Calcium and bone metabolism. In : Becker KL, Ed. Principles and Practice of Endocrinology and metabolism. Philadelphia: JD Lipincott, 1990: 398-569.
7. Jorde R, Bonaa HK, Sundsfjord J Primary hyperparathyroidism detected in a health screening: The Tromso Study. Journal of Clinical Epidemiology 2000; 53: 1164-9.
8. Health Hodgson SF, Kennedy MA. Primary Hyperparathyroidism: incidence, morbidity and potential impact in a community. NewEnglJMed 1980; 302:189_93.
9. WassifW, Kaddam I, Prentice M, Iqbal ST, Richardson A. Vitamin D deficiency and primary hyperparathyroidism presenting with repeated fractures.J Bone Joint Surg 1991:73- B:343-4.
10. Wengreen HJ, Munger RG, West NA et al Dietary protein intake and risk of osteoporotic hip fracture in elderly residents of Utab. J Bone Miner Res 2004: 19: 537-545
11. Gauger PG, Doherty GM. Parathyroid Gland. In: Townsend CM, Evers BM, Beauchamp RD, Mattox KL, editors. Sabiston Textbook of surgery. 17th ed. Philadelphia: Saunders/Elsevier;2004.p.1063-78.