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Open Access Case report

A case report: Giant cystic parathyroid adenoma presenting with parathyroid crisis after Vitamin D replacement

Ali Asghar1*, Mubasher Ikram2 and Najmul Islam1

Author Affiliations

1 Section of Endocrinology, Department of Medicine, Aga Khan University Hospital, Stadium Road, P.O. Box 3500, Karachi, 74800, Pakistan

2 Section of Otorhinolaryngology, Department of Surgery, Aga Khan University Hospital, Stadium Road, P.O. Box 3500, Karachi, 74800, Pakistan

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BMC Endocrine Disorders 2012, 12:14  doi:10.1186/1472-6823-12-14

Published: 28 July 2012

Abstract

Background

Parathyroid adenoma with cystic degeneration is a rare cause of primary hyperparathyroidism. The clinical and biochemical presentation may mimic parathyroid carcinoma.

Case presentation

We report the case of a 55 year old lady, who had longstanding history of depression and acid peptic disease. Serum calcium eight months prior to presentation was slightly high, but she was never worked up. She was found to be Vitamin D deficient while being investigated for generalized body aches. A month after she was replaced with Vitamin D, she presented to us with parathyroid crisis. Her corrected serum calcium was 23.0 mg/dL. She had severe gastrointestinal symptoms and acute kidney injury. She had unexplained consistent hypokalemia until surgery. Neck ultrasound and CT scan revealed giant parathyroid cyst extending into the mediastinum. After initial medical management for parathyroid crisis, parathyroid cystic adenoma was surgically excised. Her serum calcium, intact parathyroid hormone, creatinine and potassium levels normalized after surgery.

Conclusion

This case of parathyroid crisis, with very high serum calcium and parathyroid hormone levels, is a rare presentation of parathyroid adenoma with cystic degeneration. This case also highlights that Vitamin D replacement may unmask subclinical hyperparathyroidism. Consistent hypokalemia until surgery merits research into its association with hypercalcemia.

Keywords:
Parathyroid; Adenoma; Cystic; Hypercalcemia; Hyperparathyroidism; Vitamin D; Crisis; Mediastinum; Hypokalemia; Sestamibi