RESUMO
A 46 year-old male presented with persistently high level of serum parathyroid hormone (PTH), despite successful resection of an oxyphilic cell parathyroid adenoma of the left lower gland. Renal function and serum calcium were normal, leading to vitamin D deficiency being considered. Tc99m-sestamibi parathyroid scintigraphy showed no capitation, but a cervical ultrasound demonstrated an increase in the lower parathyroids. Surgery confirmed that the right gland was normal but the left corresponded to parathyroid carcinoma. The patient developed severe hypocalcemia, with PTH values being consistent with hypoparathyroidism for a few months. However, a progressive increase in calcium and PTH serum levels indicated recurrence of disease. Tc99m-sestamibi scintigraphy demonstrated hyperfixation in topography of the left inferior parathyroid and the patient was subjected to a third and more extensive surgery, with removal of lymph nodes and adjacent thyroid tissue. Serum calcium and PTH remained elevated, requiring loop diuretics and intravenous bisphosphonates to control hypercalcemia. Cervical radiotherapy was implemented as adjuvant therapy. After two months the patient complained of dyspnea, and a CT scan of the chest demonstrated areas of parenchymal condensation, suggestive of actinic pneumonitis. At the 2-year follow-up no major issues were evident.
Assuntos
Adenoma Oxífilo/diagnóstico , Carcinoma/diagnóstico , Diagnóstico Tardio , Erros de Diagnóstico , Neoplasias Primárias Múltiplas/diagnóstico , Neoplasias das Paratireoides/diagnóstico , Adenoma Oxífilo/fisiopatologia , Adenoma Oxífilo/radioterapia , Adenoma Oxífilo/cirurgia , Brasil , Carcinoma/fisiopatologia , Carcinoma/radioterapia , Carcinoma/cirurgia , Humanos , Hiperparatireoidismo Primário/etiologia , Hipocalcemia/etiologia , Masculino , Pessoa de Meia-Idade , Neoplasias Primárias Múltiplas/fisiopatologia , Neoplasias Primárias Múltiplas/radioterapia , Neoplasias Primárias Múltiplas/cirurgia , Neoplasias das Paratireoides/fisiopatologia , Neoplasias das Paratireoides/radioterapia , Neoplasias das Paratireoides/cirurgia , Radioterapia Adjuvante , Recidiva , Resultado do TratamentoRESUMO
Hyperparathyroid crisis is a rare, life-threatening condition that requires prompt removal of the involved parathyroid gland(s). This report describes a patient with hyperparathyroid crisis caused by a mediastinal parathyroid adenoma, which was localized before operation and removed at the initial operation, without neck exploration. Surgical approaches to hyperparathyroid crisis and the importance of preoperative localization studies are discussed.