Endocrinology and Metabolism

A Case of Mediastinal parathyroid adenoma localized by technetium-99m sestamibi scanning.: Bong Yun Cha, Kwang Woo Lee, Ho Young Son, Sung Koo Kang, Ki Ho Song, Sung Hee Lee, Won Hee Han, Hyung Sun Sohn; J Korean Endocr Soc. 1996;11(2):227-232. Published online November 7, 2019

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Abstract PDF: We present a patient with primary hyperparathyroidism in whom preoperative Tc-99m sestarnibi scanning cleary demonstrated mediastinal parathyroid adenoma. After resectian of tumor through median sternotomy, he was restored to the normocalcemia. This case suggests that Tc-99m sestamibi scanning may be a useful method in the preoperative localization of mediastinal parathyroid adenoma.

Primary Hyperparathyroidism in Children.: Han Sang Cho, Sang Ook Park, Byung Mun Lee, Yung Tak Lim, Su Yung Kim; J Korean Endocr Soc. 1994;9(3):251-257. Published online November 6, 2019

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Abstract PDF: Primary hyperparathyroidism is a rare endocrine disease in children. It involves bone and joint, urinary tract, gastrointestinal tract and cardiovascular system. The main cause of these involvement is high level of PTH in serum, resulting in hypercalcemia.An 11 years old male patient who had complained of limping gait since last 18 months, showed typical laboratory and radiological findings of primary hyperparathyroidism. At the ultrasonography, computed tomography and radionuclide scanning, a well defined mass(10 X 15mm) was found on the posterior aspect of the right thyroid lobe. The mass was confirmed histologically as adenoma of parathyroid gland. The patient was successfully treated with subtotal parathyroidectomy and temporal administration of calcium and vitamin D.We report this case of primary hyperparathyroidism with brief review of the literatures.

A Case of Primary Hyperparathyroidism Associated with Proximal Renal Tubular Acidosis and Postoperative Hungry Bone Syndrome.: Je Ho Han, Kun Ho Yoon, Bong Yun Cha, Ho Young Son, Kwang Woo Lee, Hae Ok Jung, Chang Sup Kim, Moo Il Kang, Chul Soo Cho, Ho Yun Kim, Sung Koo Kang; J Korean Endocr Soc. 1994;9(2):141-149. Published online November 6, 2019

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Abstract PDF: Primary hyperparathyroidism is a generalezed disorder of calcium, phosphorus and bone metabolism due to an increased secretion of parathyroid hormone. Single parathyroid adenoma is the most common cause of primary hyperparathyroidism. Because parathyroid hormone has been proposed as an important inhibitor of renal bicarbonate reabsorption of proximal tubule, proximal renal tubular acidosis is not rare in primary hyperparaphyroidism. After parathyroid resection, significant hypocalcemia and hypophosphatemia requiring prolonged medical management may develop, termed hungery bone syndrome. We experienced a case of primary hyperparathyroidism associated with proximal renal tubular acidosis, and severe hungry bone syndrome after resection of the adenoma of parathyroid gland.

Evaluation of Glucone Tolerance and Insulin Secretion in Two Patients with Primary Hyperparathyroidism Before and After Surgery.: Sung Hee Ihm, Moon Gi Choi, Hyung Joon Yoo, Sang Hyun Chun, Yong Seok Choi, Gun Yong Lee, In Seo Lim, Sung Woo Park; J Korean Endocr Soc. 1994;9(1):54-58. Published online November 6, 2019

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Abstract PDF: It is reported that patients with primary hyperparathyroidism(PHPT) have disturbances in carbohydrate metabolism: in particular, hyperinsulinemia and insulin resistance are characteristic early metabolic aberrations of this disease. However, it is not clear whether changes of insulin secretion or insulin sensitivity are observed in all patients with PHPT, including those with normal glucose tolerance. Also, it is not clear whether these changes are reversible after surgical correction of PHPT. In the present study, glucose tolerance and insulin secretion were evaluated in 2 symptomatic patients with PHPT during 100g oral glucose tolerance test before and after parathyroid adenoma removal. Comparing these patients before and after surgery, glucose tolerance was not significantly different. However, C-peptide and insulin secretion was low after surgical correction of PHPT compared to the preoperative situation. This observation suggests that insulin hypersecretion in patients with PHPT precedes glucose intolerance and this early disturbance is reversible after surgery.

A Case of Parathyroid Apoplexy of Primary Hyperparathyroidism Presenting as Auditory Hallucinations Accompanied with Hypocalcemia.: Eon Ju Jeon, Ji Yun Jeong, Jung Guk Kim; Endocrinol Metab. 2012;27(2):163-168. Published online June 20, 2012; DOI: https://doi.org/10.3803/EnM.2012.27.2.163

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Abstract PDF: The natural history of primary hyperparathyroidism, due to parathyroid adenoma, is unknown. Furthermore, spontaneous resolution of parathyroid necrosis or hemorrhage is rare and usually asymptomatic. Here, we report a case of parathyroid apoplexy of primary hyperparathyroidism, presenting as auditory hallucinations, accompanied with hypocalcemia. A 39-year-old man who was incidentally diagnosed with primary hyperparathyroidism, and waiting surgery for parathyroidectomy presented to psychiatric service with auditory hallucinations. He developed tetany, while taking psychiatric drugs. On a follow-up investigation, his serum calcium level fell from 11.8 to 5.8 mg/dL. His intact parathyroid hormone level also decreased from 1,017 pg/mL to 71.1 pg/mL. The parathyroid apoplexy was confirmed after a surgical removal of the infarcted adenoma. The auditory hallucinations disappeared, and serum calcium level was returned to within the normal range.

A Case of Primary Hyperparathyroidism Caused by Solitary Parathyroid Adenoma That was Not Detected by Both Ultrasonography and Sestamibi Scan.: Kyong Yong Oh, Byoungho Choi, Yukyung Lee, Do Hwan Kim, Hyon Seung Yi, Kwang Jun Kim, Sihoon Lee, Sung Kil Lim; Endocrinol Metab. 2011;26(2):166-170. Published online June 1, 2011; DOI: https://doi.org/10.3803/EnM.2011.26.2.166

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Abstract PDF

Thanks to advances in assay techniques and routine measurements in serum chemical analysis, primary hyperparathyroidism has become far more frequently detected, and the number of asymptomatic patients has substantially increased. In the majority of patients (85%), a solitary adenoma is the underlying cause of primary hyperparathyroidism. Surgical excision is the treatment of choice for most cases of primary hyperparathyroidism; this procedure has a relatively high success rate. In the past decade, improvements in preoperative imaging have played a major role in a targeted operative approach, which allows for minimally invasive surgery to be performed. The success of parathyroid surgery depends on the accurate preoperative localization of parathyroid adenoma. In this study, we report the case of a 54 year-old woman with primary hyperparathyroidism who presented with left buttock and leg pain. For localization of the parathyroid lesion, an ultrasonography and a 99mTc-sestamibi scan were initially performed, but these attempts failed to localize the lesion. We then carried out contrast-enhanced CT; thereafter, a single parathyroid adenoma was detected. Therefore, in patients with negative results on both ultrasonography and 99mTc-sestamibi scan, contrast-enhanced CT may prove helpful for preoperative parathyroid localization.

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Primary Hyperparathyroidism with Ectopic Parathyroid Adenoma Detected by Both99mTc-MIBI SPECT and Contrast-Enhanced Neck CT
Hye Jin Lim, Dong Geum Shin, Jun Bong Kim, Jin Taek Kim, Hyo Jeong Kim, Man Sil Park, Ho Jeong Lee
Korean Journal of Medicine.2012; 83(5): 641. CrossRef

A Case of Familial Isolated Primary Hyperparathyroidism with a Novel Gene Mutation.: Sung Woo Kim, Seung Jun Lee, Hyun Suk Kim, Ji Youn Kim, Eui Dal Jung, Duk Su Jung; Endocrinol Metab. 2010;25(4):374-377. Published online December 1, 2010; DOI: https://doi.org/10.3803/EnM.2010.25.4.374

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Abstract PDF: Familial isolated primary hyperparathyroidism (FIHP) is an autosomal dominant disorder that is characterized by an early stage of either multiple endocrine neoplasia type 1 (MEN1) or hyperparathyroidism-jaw tumor (HPT-JT) syndrome. We report here on a case of a 42-years old woman who was diagnosed with papillary thyroid cancer and primary hyperparathyroidism. Her younger brother also had primary hyperparathyroidism. On the genetic analysis, they were both proven to have a novel frameshift mutation in the MEN1 gene (exon 10).

A Case of Primary Hyperparathyroidism Associated with Gall-bladder Stone and Chronic Cholecystitis.: Jin Hyung Lee, Pil Moon Jung, Chong Whan Kim, Myeong Sang Shin, Hong Jun Park, Soo Min Nam, Mi Young Lee, Jang Hyun Koh, Mee Yoen Cho, Jang Yel Shin, Choon Hee Chung, Young Goo Shin; J Korean Endocr Soc. 2007;22(6):470-474. Published online December 1, 2007; DOI: https://doi.org/10.3803/jkes.2007.22.6.470

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Abstract PDF: Primary hyperparathyroidism is caused mainly by a parathyroid adenoma or hyperplasia, and is characterized by hypercalcemia and hypophosphatemia induced by an increased level of parathyroid hormone (PTH). Patients with primary hyperparathyroidism are usually asymptomatic and the disease is most often detected incidentally. However, patients can present with symptoms of renal stones, peptic ulcer disease, muscle weakness, depression, constipation, and pancreatitis. In addition, it has been reported that choletithiasis can be combined with primary hyperparathyroidism. We report a case of a 49-year-old man with primary hyperparathyroidism accompanied with chronic cholecystitis caused by a gallbladder (GB) stone. The chief complaint was nausea, poor oral intake, abdominal pain, and weight loss. Abdominal sonography was performed and chronic cholecystitis with a GB stone was diagnosed. The serum calcium level was 18.5 mg/dL and the intact parathyroid hormone level was 1,777 pg/mL. A parathyroid mass was detected by neck-computed tomography, neck ultrasonography and a (99m)Tc-Tetrofosmin parathyroid scan. The parathyroid mass was removed and the mass was confirmed as a parathyroid adenoma. Cholecystectomy was performed and the diagnosis of chronic cholecystitis was confirmed. After the surgical procedure, the symptoms improved and the calcium level was normalized.

A Case of Brown Tumor with Severe Hypercalcemia Caused by Parathyroid Adenoma.: Ji Oh Mok; J Korean Endocr Soc. 2003;18(2):221-226. Published online April 1, 2003

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Abstract PDF: Most of primary hyperparathyroidism results from parathyroid adenoma, and is characterized by hypercalcemia, reduced bone density, frequent renal stone, gastric ulcer, duodenal ulcer, muscle weakness, depression, hypertension, anemia, and rarely brown tumor. We had a case of an 80-year-old man having brown tumor caused by primary hyperparathyroidism on the right 10th rib confirmed by CT guided bone biopsy. The patient presented with decreased level of consciousness, acute gastric ulcer, acute duodenal ulcer, GB stones, renal insufficiency, depression, and osteoporosis. Serum calcium level was 16.7 mg/dL and the intact parathyroid hormone level was 3901pg/mL. A parathyroid mass was detected by neck CT and 99mTc-tetrofosmin parathyroid scan. The parathyroid tumor was removed and confirmed as a parathyroid adenoma by pathology. After operation, the patient was treated with vitamin D and calcium in response to the resulting hungry bone syndrome. The intact PTH level returned to a normal range after the removal of the parathyroid adenoma.

A Case of Metastatic Pulmonary Calcification in Primary Hyperparathyroidism.: Kwang Eun Lee, Hae Jin Kim, Si Hoon Lee, Sang Woon Bae, Eun Seok Kang, Hae Won Chung, Hye Sun Seo, Dae Jung Kim, Sang Soo Chung, Sun Jung Kim, Young Duk Song, Sung Kil Lim; J Korean Endocr Soc. 2002;17(4):583-588. Published online August 1, 2002

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Abstract PDF: Metastatic calcification is the deposition of calcium, in previously normal tissue, as a result of elevated plasma calcium and phosphorus product levels and has been reported in patients with parathyroid adenoma, parathyroid carcinoma, hyperparathyroidism due to chronic renal failure, vitamin D intoxication, and osteolytic bone tumors, such as multiple myelomas. The lungs are the most common site of metastatic calcification. We have experienced metastatic pulmonary calcification in a case of primary hyperparathyroidism. A 55-year old woman was admitted due to general weakness. From the laboratory evaluation, hypercalcemia and excess production of parathyroid hormone (PTH) were noted. technetium-99m-labelled sestamibi scintigraphy indicated an intense uptake in the lower pole area of the left thyroid gland, suggestive of a parathyroid adenoma. A technetium-99m phosphate (99mTc-MDP) bone scan showed increased uptakes in both lungs. A parathyroid lobectomy was performed, and primary hyperparathyroidism, due to a parathyroid adenoma, was finally diagnosed. A follow-up 99mTc-MDP bone scan showed the disappearance of the metastatic pulmonary calcification, with the clinical symptoms and biochemical parameters normalizing after 6 months.

A Case of Functioning Parathyroid Cancer with Hypokalemia.: Yoon Hee Choi; J Korean Endocr Soc. 1997;12(1):81-89. Published online January 1, 2001

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Abstract PDF: The parathyroid carcinoma is rare disorder and its reported incidence is 1-2% of primary hyperparathyroidism. Parathyroid cancer shows more profound clinical symptoms and signs than adenoma or hyperplasia: more severe renal and bony complications, higher calcium levels (>15 mg/dL) and palpable neck mass. It usually diagnosed after operation when it shows malignant pathologic findings, local invasion, distant metastasis, or even recurrence. The treatment is surgical resection. Hypokalemia is relatively common feature of primary hyperparathyroidism but it should be marked because of its arrhythmogenic effect when accompanies with hypercalcemia. We experienced a hyperfunctioning parathyroid carcinoma in 53 year old rnan confirmed postoperatively which showed hypokalemia normalized after operation.

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