Hypercalcemic Crisis Caused by a Parathyroid Mass Requiring Thoracoscopic Resection
| Autor: | Hadley E. Ritter, Alexandria D. McDow, Rachel C. Kim, Thomas J. Birdas, Alexandra M. Roch |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Parathyroidectomy
PHPT primary hyperparathyroidism medicine.medical_specialty Adenoma medicine.medical_treatment Parathyroid hormone 030209 endocrinology & metabolism Case Report Malignancy 03 medical and health sciences 0302 clinical medicine medicine primary hyperparathyroidism PTH parathyroid hormone Parathyroid adenoma business.industry Mediastinum hypercalcemic crisis giant parathyroid adenoma General Medicine medicine.disease Endocrine surgery medicine.anatomical_structure 030220 oncology & carcinogenesis Radiology thoracoscopic resection business Primary hyperparathyroidism |
| Zdroj: | AACE Clinical Case Reports |
| ISSN: | 2376-0605 |
| Popis: | Objective To describe the presentation, work up, and treatment of a giant parathyroid adenoma presenting as hypercalcemic crisis that ultimately weighed 57 g and extended into the mediastinum, requiring hand-assisted thoracoscopic resection. Methods The patient is a 68-year-old man with a prior history of parathyroidectomy, who initially presented with a severe hypercalcemia of 16.3 mg/dL and a parathyroid hormone (PTH) level of 2692 pg/mL on routine labs. Results Diagnostic and staging work up revealed a 7.2-cm mass extending from just superior to the sternal notch into the right posterior mediastinum to the carina, causing esophageal displacement. No evidence of local invasion or distant metastasis was observed on further imaging, and cytology demonstrated hypercellular parathyroid tissue. The PTH level of the aspirate was >5000 pg/mL. The patient subsequently underwent a right hand-assisted video-assisted thoracoscopic resection of the intrathoracic mass. Final pathology identified a 7.0-cm, 57-g parathyroid adenoma, without any pathologic findings suspicious for malignancy. However, the endocrine surgery team plans for annual laboratory assessment to ensure no recurrence. Conclusion Primary hyperparathyroidism is most commonly caused by a single adenoma. However, in the setting of severe hypercalcemia and elevated PTH, one must have a high suspicion for malignancy, and care should be taken to remove the mass en bloc. For extremely large adenomas extending into the mediastinum, a minimally invasive, hand-assisted, thoracoscopic approach is a safe and effective method of resection. |
| Databáze: | OpenAIRE |
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