Session: SAT 199-223-Disorders of Bone & Calcium Homeostasis: Case Reports
Poster Board SAT-209
Case 1: A 35yo female had persistent hypercalcemia after 4 parathyroidectomies. Her labs were: Ca-11.3mg/dL (normal 8.5-10.3 mg/dL), PTH-251pg/mL (normal 12-88 pg/mL). Sestamibi showed abnormal uptake and CT scan of the chest showed multiple nodules in the mediastinum. She underwent 3 more surgeries to remove this abnormal tissue. Pathology each time confirmed parathyromatosis. Despite 7 surgeries, the patient is hypercalcemic (12-13 mg/dL) and requires Cinacalcet and periodic IV Zoledronic Acid. She is currently undergoing familial genetic testing.
Case 2: A 41yo female had persistent hypercalcemia. Her labs were Ca-11.3 mg/dL, PTH-61.2pg/mL. Sestamibi showed single gland uptake. She underwent a parathyroidectomy and pathology showed multi-gland hyperplasia. Postoperatively, she remained hypercalcemic. Repeat Sestamibi was normal but a neck CT showed a lesion in the mediastinum. She underwent her second parathyroidectomy with pathology consistent with parathyromatosis. She remained hypercalcemic: Ca-10.5 mg/dL, PTH-100pg/mL and she began medical management with Cinacalcet.
Case 3: A 47yo female had recurrent hypercalcemia despite 4 parathyroidectomies. At presentation, her labs were: Ca-16.5mg/dL, PTH-317pg/mL. Sestamibi showed abnormal uptake in the thyroid and neck CT revealed 2 nodules in the mediastinum. She had her 5th neck exploration. Pathology was consistent with parathyromatosis. She remained normocalcemic for a year then her hypercalcemia recurred: Ca-13.3 mg/dL, PTH-65pg/ml. She was given IV Zoledronic Acid and started on Cinacalcet.
Conclusion: We present a case series of 3 patients with recurrent or persistent primary hyperparathyroidism from parathyromatosis. These patients have debilitating symptoms despite multiple operations. Medical therapy to control symptoms of hypercalcemia in parathyromatosis is limited and minimally effective.
Nothing to Disclose: AE, RP, JK, IJ, RJB
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