: Ectopic parathyroid adenomas have a low imaging incidence quoted at 1.4% in patients undergoing investigation for primary hyperparathyroidism with a prevalence of 630%. These are reported to have a more clinically severe manifestation of the disease, frequently with higher calcium levels and bone disease. Remission due to parathyroid infarction is a rare occurrence. We report a 54-yr Afro-Carribean/mixed race female who presented with lethargy, weight loss and reduced oral intake for 3 months. She reported no significant past medical history and was not on any medications. Admission biochemistry revealed significantly raised calcium of 4.58 mmol/l, PTH 51.6 pmol/l, Alk Phos 190 IU/l indicating primary hyperparathyroidism with severe Vit D depletion <12.5 nmol/l. She was admitted to the acute medical unit, treated with IV normal saline, received 90 mg of IV pamidronate and high dose Vit D supplementation. US neck and CT scan confirmed right lower pole parathyroid adenoma, extending into the mediastinum with associated bone disease with patchy bone marrow changes throughout her spines suggestive of Brown Tumours on MRI scan. Interestingly 10 days later she developed symptomatic hypocalcaemia with spontaneous reduction of PTH requiring treatment with IV calcium, this is likely related to the fact that she might have developed hungry bone syndrome following spontaneous resolution of her hyperparathyroid state or parathyroid intoxication. MRI neck scan showed 44 mm cystic lesion lying on the deep aspect of the right lobe of the thyroid with enhancing tissue suggestive of possible viable adenoma or perilesional inflammation. The overall picture was consistent with parathyroid infarction. 6 weeks post admission, her PTH level normalisedand calcium remained within range. Spontaneous infarction of the parathyroid has been reported but is rare. Published reports have recommended careful monitoring and consideration of parathyroidectomy as regeneration may occur.
|Calcium (mmol/l)||PTH (pmol/l)||Alk Phos (IU/l)|
|10 days post treatment||1.88||17.6||534|
|On discharge (2 wks post)||2.29||429|
|6 wks post presentation||2.40||6.8||189|