Neither a Friend nor a Foe: An Unusual Case of Severe Symptomatic Hypercalcemia Secondary to Atypical Parathyroid Adenoma
https://doi.org/10.15605/jafes.041.S1
- Author:
Wye Hong Leong
1
;
Qing Ci Goh
1
;
Vanusha Devaraja Pillai
1
;
Siow Ping Lee
1
;
Maryam Ahmad Sharifuddin
2
Author Information
1. Endocrinology Unit, Department of Medicine, Hospital Melaka
2. Department of Pathology, Hospital Melaka
- Publication Type:Journal Article
- MeSH:
Hypercalcemia;
Parathyroid Neoplasms
- From:
Journal of the ASEAN Federation of Endocrine Societies
2026;41(S1):79-80
- CountryPhilippines
- Language:English
-
Abstract:
Introduction:Atypical parathyroid adenoma (APA) constitutes approximately 0.5–4.0% of all cases of primary hyperparathyroidism (pHPT). Here, we report a case of APA
presenting with severe hypercalcemia, complicated with
renal impairment, bilateral medullary nephrocalcinosis,
and multiple fragility fractures.
Case:A 45-year-old male initially presented with a 6-month
history of constipation, polyuria, lethargy, bone pain,
and difficulty in initiating micturition. Laboratory
investigations revealed impaired renal function with
an estimated glomerular filtration rate of 41.4 mL/min,
severe hypercalcemia (4.07 mmol/L), and an elevated
intact parathyroid hormone (iPTH) level of 104.0 pmol/L
(reference range: 1.58–6.03 pmol/L), confirming the
diagnosis of pHPT. He was also found to have vitamin D deficiency, with a serum total 25-hydroxyvitamin D level
of 46 nmol/L.
Ultrasound of the abdomen demonstrated bilateral
medullary nephrocalcinosis, while neck ultrasound and
Tc-99 m sestamibi parathyroid scintigraphy revealed a
concordant lesion in the posterior aspect of the left thyroid
lobe, suggestive of a parathyroid adenoma.
He returned 3 months later with closed fractures of the right
subtrochanteric femur and the right humerus following
a fall from standing height.
In view of persistent hypercalcemia despite hyperhydration and treatment with zoledronic acid, subcutaneous
denosumab (60 mg) was administered, resulting in an
improvement in serum calcium levels. A left inferior
parathyroidectomy was then performed concurrently
with internal fixation of the right femur. The surgery was
uneventful. Histopathological examination confirmed an
atypical parathyroid adenoma. Postoperatively, the serum
calcium and iPTH levels normalized, and the patient
remained asymptomatic and normocalcemic during
regular follow-up.
Conclusion:APA remains a diagnostic and therapeutic challenge due
to its clinical, biochemical, and histopathological features
of equivocal malignancy. Surgical resection remains
the mainstay of management of APA, and long-term
surveillance is essential in view of its uncertain malignant
potential and risk of recurrence.
- Full text:2026080413391051669EP_A109.pdf
