ECE2023 Eposter Presentations Calcium and Bone (99 abstracts)
A case of a giant parathyroid adenoma associated with a secondary hyperparathyroidism in a hemodialysis patient
Houas Jihene 1 , BelHadj Miled Heyfa 1 , Ghammam Monia 1 , Kechiche Jawaher 1 , El Omri Malika 1 , Bellakhdher Mouna 1 , Hasni El Abed Yosra 2 , Meherzi Abir 1 , Kermani Wassim 1 & Abdelkefi Mohamed 1
1ENT Department and Neck Surgery of Farhat Hached Hospital, Sousse, Tunisia; 2Endocrinology department Farhat Hached Hospital, Sousse, Tunisia
Introduction: Secondary and tertiary hyperparathyroidism (HPT) usually result from parathyroid gland hyperplasia that produces excess parathyroid hormone (PTH). Collectively, secondary and tertiary HPT comprise a minority of the patients diagnosed with HPT. Due to the relative rarity of these conditions and common underlying disease pathology, they are frequently discussed and researched together. While the disease processes are related, secondary and tertiary HPT are two distinct and separate entities.
Patients and Methods: We report a case of a giant parathyroid adenoma associated with a secondary hyperparathyroidism in a hemodialysis patient observed in our department of otorhinolaryngology and cervicofacial surgery.
Observation: The patient is 70 years old, diabetic, coronary and chronic renal failure, and has been on haemodialysis since 2019. She had been suffering from diffuse bone pain for a year with functional impotence, especially in the two lower limbs. A parathyroid workup revealed a blood calcium level at the upper limit of normal and an elevated PTH level of 1160 pg/ml even after correction of hypovitaminosis D. Scintigraphy found two MIBI-binding sites, one of which is large and projects below the left lower pole. MRI and CT scan found a 4 cm calcified left basicervical mass extending into the upper mediastinum. The patient underwent a subtotal parathyroidectomy with removal of the subthyroidal lower laterotracheal mass. The postoperative follow up was straightforward. The PTH was back to 35 pg/ml on postoperative day 3 with a blood calcium level of 2.05 mmol/l. Pathological examination concluded to a giant parathyroid adenoma associated with hyperplasia of the remaining parathyroids. The evolution was marked by a regression of bone pain.
Conclusion: Tertiary HPT is classically caused by hyperplasia of all four glands, though some reports indicate that over 20% of patients may have single or double adenomas as the underlying pathology. Management is essentially based on surgical treatment.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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