Spontaneous regression of hypercalcemia in a patient with primary hyperparathyroidism and prolactinoma

Spontaneous Remission After a Hypercalcemic Crisis Caused by an Intracystic Hemorrhage of Bilateral Parathyroid Adenomas: A Case Report and Literature Review

BACKGROUND

Hyperparathyroidism is a common cause of hypercalcemia; however, spontaneous remission after a hypercalcemic crisis caused by an intracystic hemorrhage of parathyroid adenomas is very rare. The question, then, is "What is the best treatment strategy for this type of case?"

METHOD

A 47-year-old male patient with primary hyperparathyroidism and a hypercalcemic crisis is reported. Hypercalcemia was spontaneously relieved thereafter. Postoperative paraffin pathology results indicated an intracystic hemorrhage of bilateral parathyroid adenomas.

RESULTS

After the case report, a literature review is also included to summarize the clinical features of this patient and to provide special reference for clinical diagnosis and treatment of similar cases.

CONCLUSIONS

The choice of surgical timing for such cases can be made based on the comprehensive consideration of clinical symptoms and changes in parathyroid function.

What predicts adverse outcomes in untreated primary hyperparathyroidism? The Parathyroid Epidemiology and Audit Research Study (PEARS)

OBJECTIVE

This study aims to identify the best biochemical risk factors alongside other factors for predicting adverse outcomes seen in untreated primary hyperparathyroidism (PHPT).

DESIGN

Population-based cohort study, 1997-2006.

SETTING

Tayside, Scotland, UK.

PATIENTS

Patients with untreated diagnosed PHPT. OUTCOME MEASURES AND METHODS: Outcomes considered were all-cause mortality, fatal and nonfatal cardiovascular disease (CVD). Models were derived using survival analysis. Potential biochemical predictors tested were baseline serum calcium, parathyroid hormone (PTH), creatinine and alkaline phosphatase (ALP), and other covariates considered were gender, age at diagnosis, deprivation, previous comorbidities and bisphosphonates usage.

RESULTS

From 1997 to 2006, 2097 patients (mean age, 68·4 years; 69·9% women) with untreated PHPT were identified with a total follow-up of 7338 person years, in the population of Tayside, Scotland. The median baseline calcium was 2·61 mm, and PTH was 7·2 pm. PTH was the only statistically significant risk factor in all outcomes observed adjusting for other covariates. Serum creatinine and ALP predicted mortality outcomes in the short term (≤3 years), but not long term. Calcium was associated with increased risk of all-cause mortality in the short term but had no significant impact on other outcomes.

CONCLUSION

Baseline PTH, rather than calcium, best predicts long-term outcomes in untreated PHPT.

Spontaneous remission of primary hyperparathyroidism: A case report and meta-analysis of the literature

BACKGROUND

In a minority of patients, primary hyperparathyroidism spontaneously remits either by autoinfarction or by hemorrhage into or around the adenoma. We describe a case of autoparathyroidectomy occurring in a 63-year-old man 9 years after three parathyroid glands were removed during a total thyroidectomy. This case is compared with 50 previously reported cases of autoparathyriodectomy, and a meta-analysis is performed.

METHODS

Case report, literature review, and meta-analysis were done using statistical software (SigmaStat 2.0, SPSS, Chicago).

RESULTS

Fifty cases of autoparathyroidectomy were summarized according to the three etiologies. The greatest biochemical aberration was found in the acute intracapsular hemorrhage group, with [Ca(++)] falling from a mean 15.1 mg/dL to 8.9 mg/dL. The average drop in parathyroid hormone was 69% across all groups, comparing favorably to surgical resection.

CONCLUSIONS

Autoparathyroidectomy is a rare but described outcome of unoperated primary hyperparathyroidism that may delay or supplant operative management.