Endocrine Abstracts

Introduction: Primary hyperparathyroidism is a common cause for hypercalcemia, however severe hypercalcemia remain a rare complication. The atypical parathyroid adenoma is an uncommon cause to severe hypercalcemia. We report a case of a 40-year-old male with very high serum calcium due to a possible atypical parathyroid diagnosed after a spontaneous fracture.

Case report: A 40-year-old male was admitted to the traumatology department for the management of spontaneous fracture of the humerus. The clinical history revealed clinical symptoms of hypercalcemia (abdominal pain, neurologic irritation, asthenia, etc.). The initial blood work up found a severe hypercalcemia (203 mg/l) hypophosphoremia (23 mg/l) and high ALP. Parathyroid hormone level were of 749 pg/ml. The patient underwent a surgical en bloc resection after the localization of a right inferior parathyroid adenoma. Pathology showed a mixed picture consistent with possible atypical adenoma versus parathyroid carcinoma. However, due to the absence of local structures involvement, atypical parathyroid adenoma was more likely. The immunohistochimie: paratyhroidien adenoma atypical. The evolution was marked by the improvement of the clinical signs and calcium normalization.

Conclusion: It can be very difficult to distinguish between atypical parathyroid adenomas and parathyroid carcinomas as in our case and no clear-cut guidelines yet exist to differentiate the two based on histology. Close follow-up is mandatory to detect any local recurrence.