Searchable abstracts of presentations at key conferences in endocrinology
Endocrine Abstracts (2009) 19 P179

SFEBES2009 Poster Presentations Endocrine tumours and neoplasia (32 abstracts)

Probable recurrence of spontaneously resolved primary hyperparathyroidism

Subhash C Rana , Cho Zaw , Vijay Bangar & Abdusalam Mousa


Calderdale Royal Hospital, Halifax, West Yorkshire, UK.


Objective: We present a case of primary hyperparathyroidism awaiting surgery that has probable spontaneous resolution lasting only 4 months, supposedly because of asymptomatic infarction or haemorrhage. Her PTH has risen again though her Ca is still normal. Two such cases have been described in the literature.

Case report: A 74-year-old ex-smoker, hypertensive female was admitted with two days history of confusion, lethargy and feeling unwell.

On examination she was severely confused and dehydrated.

Investigations: FBC; Neutrophil leucocytosis

Urea & electrolytes: Na 151 mmol/l, K 3.5 mmol/l, urea 19.0 mmol/l, Creatinine 138 μmol/l Calcium 5.06 mmol/L, Po4 1.32 mmol/l, Parathormone 68.3 pmol/l, Vitamin D 87 nmol/l. TSH 0.49 mU/l.

Normal CRP, CEA and Immunoglobulins.

ECG: widespread ST depression, Troponin-I 0.77 (No history of chest pain).

CXR: normal

She was treated for hypercalcaemia with fluids and Pamidronate. A diagnosis of primary hyperparathyroidism was made & tests were were arranged to look for end organ damage.

Dexa scan: T score -3

Ultrasound KUB: normal

Ultrasound & MRI neck: 6×7 mm hypoechoic nodule consistent with parathyroid adenoma.

Sestamibi scan: normal.

As per the guidelines she was referred for parathyroid surgery. Surprisingly her PTH level has dropped from 68.3 originally to 19.7 pmol/l with Ca 2.42 mmol/l in May and PTH 8.8 pmol/l & Ca 2.57 mmol/l in June 2008. But again in October her PTH has risen to 12.9 pmol/l though her calcium 2.58mmol/L is in the normal range.

Conclusion: In literature, we have across only 2 cases of recurrence of spontaneously resolved primary hyperparathyroidism. Our patient presented with high Ca and PTH and became normal for 4 months before her PTH raised again though Ca is still normal. It would be interesting to watch if her PTH will increase further & she becomes hypercalaemic again to warrant re-referral for surgery.

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