Hypercalcemia in accelerated phase of chronic myelogenous leukemia (CML) is very rare. Its pathogenesis is considered humoral hypercalcemia of malignancies mediated by parathyroid hormone-related protein (PTHrP). In severe hypercalcemia, calcifications in kidneys, skin, vessels, heart, and stomach may occur. Our two cases were admitted because of severe hypercalcemia in accelerated phase of CML. On Tc-99m methylene diphosphonate (MDP) bone scintigraphies, a marked tracer accumulation was seen in the lung, heart, stomach and kidney. We report increased tracer accumulation of multiple organs on Tc-99m MDP bone scintigraphy in two rare hypercalcemic patients with CML.
Adult ; Bone Diseases/radionuclide imaging* ; Bone Diseases/etiology* ; Calcinosis/radionuclide imaging ; Calcinosis/etiology ; Case Report ; Human ; Hypercalcemia/radionuclide imaging* ; Hypercalcemia/etiology* ; Leukemia, Myeloid, Chronic/metabolism ; Leukemia, Myeloid, Chronic/complications* ; Male ; Middle Age ; Proteins/metabolism ; Technetium/diagnostic use

Sarcoidosis is a systemic granulomatous disease of unknown etiology that involves many organs, occasionally mimicking malignancy. We herein report a 50-yr-old woman of muscular sarcoidosis of chronic myopathic type, manifested by hypercalcemia and muscle wasting. Besides insignificant hilar lymphadenopathy, her sarcoidosis was confined to generalized atrophic muscles and therefore, F-18 FDG PET/CT alone among conventional imaging studies provided diagnostic clues for the non-parathyroid-related hypercalcemia. On follow-up PET/CT during low-dose steroid treatment, FDG uptake in the muscles disappeared whereas that in the hilar lymph nodes remained. PET/CT may be useful in the evaluation of unexpected disease extent and monitoring treatment response in suspected or known sarcoidosis patients.
Female ; Fluorodeoxyglucose F18/*diagnostic use ; Humans ; Hypercalcemia/complications/*diagnosis ; Kidney Calculi/complications/diagnosis ; Lymph Nodes/radionuclide imaging ; Middle Aged ; Positron-Emission Tomography ; Radiopharmaceuticals/*diagnostic use ; Sarcoidosis/complications/drug therapy/*radionuclide imaging ; Steroids/therapeutic use ; Tomography, X-Ray Computed

A 66-year old presented with hypercalcemia with a 6 month duration. She was a MEN-I patient with a pancreas islet cell tumor and a pituitary adenoma. The clinical examination revealed no mass lesion of the neck. The serum calcium was elevated. Parathyroid scintigraphy showed a high uptake of 4 parathyroid glands that were compatible with hyperparathyroidism. During the operation, five parathyroid glands were identified, two at the right side and three at the left. All five glands were found to have hyperplasia by the pathologist. She underwent subtotal parathyroidectomy. She was discharged on the 8th post operative day and has been followed up without any evidence of recurrence for 36 months.
Adenoma, Islet Cell ; Aged ; Calcium ; Humans ; Hypercalcemia ; Hyperparathyroidism ; Hyperplasia ; Multiple Endocrine Neoplasia Type 1 ; Neck ; Pancreas ; Parathyroid Glands* ; Parathyroidectomy ; Pituitary Neoplasms ; Radionuclide Imaging ; Recurrence

A cystic parathyroid adenoma is rare. A case of primary hyperparathyroidism, with the cystic formation of a parathyroid adenoma and a severe bony lesion, is reported. A 52-year-old male was admitted due to pain in both hips and for evaluation of hypercalcemia. The plasma level of the intact parathyroid hormone(iPTH) was elevated to 1424pg/mL. Ultrasonography and the computed tomography revealed a parathyroid cyst on the left thyroid lower pole. Parathyroid scintigraphy detected a parathyroid adenoma. A radiograph showed a subperiosteal bone resorption on the phalanges, and a brown tumor(osteitis fibrosa cystica) on the femur shaft was noted. A surgical excision of the parathyroid adenoma was performed. The PTH level in the cystic fluid was increased. A histological examination confirmed a cystic parathyroid adenoma. The PTH level was normalized after the operation.
Bone Resorption ; Femur ; Hip ; Humans ; Hypercalcemia ; Hyperparathyroidism ; Hyperparathyroidism, Primary ; Male ; Middle Aged ; Osteitis Fibrosa Cystica ; Parathyroid Neoplasms* ; Plasma ; Radionuclide Imaging ; Thyroid Gland ; Ultrasonography

The parathyroid hormone related protein(PTHrP) is the most common causative peptide of humoral hypercalcemia of malignancy. In contrast, the serum level of parathyroid hormone(PTH) is low to undetectable in the majority of patients with malignancy associated hypercalcemia. Few cases exist in which the production and secretion of PTH by malignant nonparathyroid tumors have been authenticated. To our knowledge, there is very rare case in which a nonparathyroid tumor expressed simultaneously both the PTH and PTHrP. We report a case of squamous cell carcinoma of the lung with hypercalcemia which presented with simultaneous elevation of serum PTH and PTHrP. Severe hypercalcemia (serum calcium, 7.5mEq/L) was found in a 65-year-old man who had a squamous cell carcinoma of the lung without any body metastasis and detectable parathyroid abnormalities on isotope scintigraphy. The serum level of intact parathyroid hormone (PTH) concentration was markedly elevated as measured in two site radioimmunoreactive PTH assays (intact PTH 150pg/mL ; normal 9~55). The serum level of a PTHrP was also increased as measured in C-terminal region specific radioimmunoassay (PTHrP 99.1 pmol/L ; normal 13.8~55.3). There are no evidences of coincidental primary hyperparathyroidism in parathyroid MIBI scan and other imaging studies including neck ultrasonography and computed tomography. These results suggest that simultaneous elevation of serum PTH and PTHrP in this patient can be caused by production of both PTHrP and PTH in other nonparathyroid lesions such as squamous cell carcinoma.
Aged ; Calcium ; Carcinoma, Squamous Cell ; Humans ; Hypercalcemia* ; Hyperparathyroidism, Primary ; Lung Neoplasms* ; Lung* ; Neck ; Neoplasm Metastasis ; Parathyroid Hormone ; Parathyroid Hormone-Related Protein ; Radioimmunoassay ; Radionuclide Imaging ; Ultrasonography

We report the first case of hypercalcemia-induced acute pancreatitis caused by a functioning parathyroid cyst in a 67-year-old man. Laboratory investigation revealed increased serum amylase and lipase, increased serum ionized calcium and parathyroid hormone (PTH) levels, and decreased serum phosphate, indicating pancreatitis and primary hyperparathyroidism (PHPT). Abdominal computed tomography (CT) revealed mild swelling of the pancreatic head with peri-pancreatic fat infiltration and fluid collection around the pancreatic tail. Ultrasonography and CT of the neck showed a cystic lesion at the inferior portion of the left thyroid gland, suggesting a parathyroid cyst. There was no evidence of parathyroid adenoma by 99mTc sestamibi scintigraphy. PHPT caused by a functioning parathyroid cyst was suspected. The patient underwent surgical resection of the functioning parathyroid cyst owing to his prolonged hypercalcemia. At 3 weeks after the operation, his serum levels of PTH, total calcium, ionized calcium, inorganic phosphate, amylase, and lipase were normalized. At the follow-up examinations, he has remained asymptomatic.
Aged ; Amylases ; Calcium ; Follow-Up Studies ; Head ; Humans ; Hypercalcemia ; Hyperparathyroidism, Primary ; Lipase ; Neck ; Pancreatitis ; Parathyroid Hormone ; Parathyroid Neoplasms ; Radionuclide Imaging ; Technetium Tc 99m Sestamibi ; Thyroid Gland ; Ultrasonography

Multiple endocrine neoplasia type 1 (MEN1) is an autosomal dominant tumor syndrome. Thymic carcinoid tumors in MEN1 are not common and their natural history is little known. But development of thymic carcinoid tumors is important because in 1993, they were identified as a frequent case of death. There has not been a report of case in Korea so far. We encountered a case of thymic carcinoid in MEN1. A 42 year old man was referred presenting with diabetes of 12 years duration. Abnormal findings in his blood chemistry were hypercalcemia and hyperprolactinemia. 99mTc- sestamibi scintigraphy showed parathyroid adenoma and hyperplasia. Sella MRI showed pituitary macroadenoma. Abnormal CT scan demonstrated multiple pancreas islet cell tumors, bilateral adrenal tumor and thymoma. Subtotal parathyroidectomy with thymectomy was perfomed and thymic carcinoid was confirmed. This is the first report of thymic carcinoid with MEN1 in Korea.
Adenoma, Islet Cell ; Adult ; Carcinoid Tumor* ; Chemistry ; Humans ; Hypercalcemia ; Hyperplasia ; Hyperprolactinemia ; Korea ; Magnetic Resonance Imaging ; Multiple Endocrine Neoplasia Type 1* ; Multiple Endocrine Neoplasia* ; Natural History ; Pancreas ; Parathyroid Neoplasms ; Parathyroidectomy ; Radionuclide Imaging ; Thymectomy ; Thymoma ; Tomography, X-Ray Computed

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.
Calcium ; Female ; Follow-Up Studies ; Humans ; Hypercalcemia ; Hyperparathyroidism ; Hyperparathyroidism, Primary* ; Kidney Failure, Chronic ; Lung ; Middle Aged ; Multiple Myeloma ; Parathyroid Hormone ; Parathyroid Neoplasms ; Phosphorus ; Plasma ; Radionuclide Imaging ; Technetium Tc 99m Medronate ; Thyroid Gland ; Vitamin D