A Case of Primary Hyperparathyroidism Found by Parathyroid Crisis

A 75-year-old women, who had been well until 2 weeks ago, consulted a phychiatrist because of stupor and appetite loss. A high serum calcium level (16.4mg/dl) was found and she was referred to our department. Calcium level rapidly increased to 25.2 mg/dl within a week regardless of a large amount of saline infusion with simultaneous administation of diuretics, calcitonin and prednisolone. Serum calsium level decreased gradually after six times of hemodialyses and infusion of bisphosphonate, pamidronate disodium. The level of intact PTH turned out to be extremely high (520pg/ml) and PTH-related protain was in the normal range. Parathyroid crisis due to primary hyparathyroidism was diagnosed. Procedures aim to localize the affected parathyroid glands including ultrasonography, computed tomography, magnetic resonance imaging and subtraction scintigraphy failed. Technetium 99m sestamibi scan after sedation with diazepan showed an abnormal image just below the right lobe of the thyroid. During the neck operation, an adenoma (3 x 1 cm) was detected and resected completely. No other affected glands were found. The levels of serum calcium due to persistent hypercalcemia remained six months later after the operation.

hyperparathyroidism

parathyroid crisis

intact-PTH

hypercalcemia