Elevated Intact Parathyroid Hormone Produced by a Cervical Neuroendocrine Tumor
| Autor: | Alfonso Pumar López, Raquel Guerrero Vázquez, Ignacio Cuenca Cuenca, Miguel Ángel Japón, Suset Dueñas Disotuar, Alfonso Soto Moreno |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2018 |
| Předmět: |
Pathology
medicine.medical_specialty endocrine system diseases Endocrinology Diabetes and Metabolism 030209 endocrinology & metabolism 030204 cardiovascular system & hematology Epigastric pain Diseases of the endocrine glands. Clinical endocrinology Lesion 03 medical and health sciences 0302 clinical medicine Polyuria medicine Parathyroid adenoma Hyperparathyroidism medicine.diagnostic_test biology business.industry Chromogranin A medicine.disease RC648-665 biology.protein medicine.symptom business Primary hyperparathyroidism Emission computed tomography hormones hormone substitutes and hormone antagonists |
| Zdroj: | AACE Clinical Case Reports, Vol 4, Iss 4, Pp e316-e319 (2018) |
| ISSN: | 2376-0605 |
| Popis: | Objective: To describe the diagnosis of a case of hypercalcemia secondary to elevated intact parathyroid hormone (iPTH) due to a cervical neuroendocrine tumor. Methods: We present the clinical, laboratory, and imaging findings of the case, along with a review of the literature. Results: A 69-year-old man with a history of bradypsychia, polyuria, and epigastric pain was hospitalized for hypercalcemia (13.7 mg/dL). The patient had elevated iPTH (326 pg/mL), suggesting primary hyperparathyroidism. An ultrasound and parathyroid single-photon emission computed tomography scan identified a possible left inferior parathyroid adenoma. The suspicious parathyroid lesion was surgically removed. The original mass was found to be normal but another tumor was found and identified as a solid, 5-cm infiltrating tumor which was not completely resected. Immunohistochemistry showed that the tumor was compatible with a neuroendocrine tumor, clearly positive for chromogranin and focally for iPTH. Postoperatively, his chromogranin A level was elevated (435 ng/mL). Scintigraphy with radiolabeled octreotide was positive in the cervical area without metastasis elsewhere. Calcemia and iPTH levels reduced sharply postoperatively, but began to rise after 1 month. Considering that resection was incomplete, chemotherapy was initiated along with cinacalcet and somatostatin analog administration, resulting in additional decrease in serum calcium levels (10.5 to 11 mg/dL) and disease stabilization. Conclusion: This case highlighted a challenging diagnosis wherein an extra parathyroid tumor could produce ectopic iPTH. Biochemical and hormonal patterns compatible with primary hyperparathyroidism may not always be related to a parathyroid adenoma. |
| Databáze: | OpenAIRE |
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