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Case Report
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| Determining primary from secondary hyperparathyroidism: A review of current management | ||||||
| Michael Smith1, Sherwin Schrag2 | ||||||
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1DO, Department of Surgery, St Barnabas Hospital, Bronx, NY.
2MD, Department of Surgery, Jersey City Medical Center, Jersey City, NJ. | ||||||
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| Smith M, Schrag S. Determining primary from secondary hyperparathyroidism: A review of current management. Int J Case Rep Imag 2016;7(6):365–369. |
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Abstract
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Introduction:
Primary hyperparathyroidism is the third most common endocrine disorder and the most common cause of hypercalcemia. Since the advent of automated serum chemistry machines, it is more common for hypercalcemia to be discovered incidentally. Secondary hyperparathyroidism is seen in the setting of chronic renal insufficiency. Both result in elevated parathyroid levels and in a patient with underlying renal disease distinguishing the primary from the secondary disease may be difficult.
Case Report: A 60-year-old female presented to an emergency department with the complaints of constipation, weakness, dizziness that began acutely. She began to receive routine renal replacement therapy one month prior to presentation. A serum calcium level of 15 mg/dl was found on routine blood work. Further workup revealed a parathyroid hormone level of over 1000 pg/mL. Ultrasonography of the neck and sestamibi scan confirmed the location of the suspected lesion. On removal of the mass, which histologic examination revealed to be a 6.2 grams parathyroid adenoma, her calcium level returned to normal. Conclusion: Primary hyperparathyroidism requires surgical intervention for definitive therapy. Secondary hyperparathyroidism requires optimization of medical therapies to treat effectively in lieu of renal transplantation. In patients with underlying renal insufficiency and elevated calcium levels, imaging should be used to rule out parathyroid adenomatous disease and parathyroid carcinoma. | |
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Keywords:
Parathyroid adenoma, Parathyroid carcinoma, Primary hyperparathyroidism, Secondary hyperparathyroidism
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Author Contributions
Michael Smith – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published Sherwin Schrag – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published |
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Guarantor of submission
The corresponding author is the guarantor of submission. |
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Source of support
None |
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Conflict of interest
Authors declare no conflict of interest. |
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Copyright
© 2016 Michael Smith et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information. |
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