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

Abstract

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)

Spectrum of Disorders associated with Tetany

“…38,39 Tetany is very rarely reported with parathyroid apoplexy. 40 Autoimmune hypoparathyroidism occurs in isolation or as a part of a polyglandular endocrinopathy, usually autoimmune polyglandular syndrome type 1 (APS-1). 35 Hypocalcemia and tetany are also seen in APS-2, but this hypocalcemia is more likely due to malabsorption from celiac disease than hy p op arathy roidism .…”