Refractory hypercalcemia due to an ectopic mediastinal parathyroid gland in a hemodialysis patient: a case report

Abstract

Background Hypercalcemia crisis is a complex disorder rarely induced by tertiary hyperparathyroidism, which clinically presents as nonsuppressible parathyroid hyperplasia with persistent increased PTH levels and hypercalcemia. It is one of the major risk factors of morbidity and mortality in end-stage renal disease. Parathyroidectomy should be in consideration in dialysis patients with severe hyperparathyroidism who are refractory to medical therapy. The implications and consequences of it, however, are not fully understood. Case presentation We present a case of a 70 year-old man disturbed by gastrointestinal manifestations due to hypercalcaemic crisis. The patient had longstanding hypercalcaemia and hyperparathyrodism refractory to calcimimetics, calcitonin, hormone and haemodialysis. A ectopic parathyroid gland in anterior mediastinum was found and elucidated by Tc-99 m scan. Futhermore, a video-assisted thoracoscopic parathyroidectomy was performed. Histologically, the tumour consisted of densely arranged chief cells immunohistochemically positive for PTH antigens. Consequently, calcium and parathormone were declining stably without any complications. Conclusions On account of refractory hypercalcemia and hyperparathyroidism, radionuclide scanning is useful in the diagnosis of ectopic parathyroid gland. it is of great significance for multidisciplinary therapy combing anesthesia, surgical, endocrinology and nephrology staff.

Hungry bone syndrome after parathyroid surgery

“…Nevertheless, only 85.0% and 75.8% of patients underwent parathyroid ultrasound and scanning before surgery, respectively. Although not very common, ectopic or supernumerary parathyroid glands, [29][30][31][32][33][34] could account for the persistence or recurrence of hyperparathyroidism after parathyroid surgery. Abruzzo et al 31 proposed that diagnostic imaging has an indispensable role because during the first surgical intervention, it helps to have an idea of the possible location of the parathyroid glands, and to avoid the risk of persistence or recurrence due to ectopic or supernumerary parathyroid glands.…”

Parathyroid Carcinoma in a Patient With Secondary Hyperparathyroidism and Thyroid Hemiagenesis: A Case Report and Review of the Literature

“…19 In addition, PC has occurred in ectopic parathyroid glands of the mediastinum. 20,25 Parathyroid carcinoma arising from autotransplanted parathyroid tissue has also been reported. 26 The ratio of men to women among patients with PC is roughly 1:1.…”

“…5 In the English-language literature, there have been 34 reports to our knowledge (Table 1). 16 -27 Typically, each of the 4 parathyroid glands shows different pathological findings. 1 6 Bilateral PC has been reported.…”