Spontaneous resolution and recurrence of hypercalcemia in primary hyperparathyroidism--anecdotal observations with potential implications for parathyroid pathophysiology in renal disease

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.