Purpose: The objective of this paper is to report the management and treatment of a 47-year-old patient admitted with multiple problems including asthenia, nausea and bradycardia, and was diagnosed with a giant parathyroid adenoma. Case report: A 47-year-old man was admitted to the Department of General Surgery for acute and worsening asthenia, nausea and bradycardia. Blood tests showed hypercalcemia, hypophosporemia, very high serum parathormone level, so that he was diagnosed with primary hyperparathyroidism. Cervical ultrasonography and scintigraphy with technetium 99 mTc Methoxyisobutylisonitrile (99 mTc-MIBI) showed the presence of positive nodule at the isthmus of the thyroid gland. The patient underwent neck exploration. Intra-operative iPTH essay was measured. A giant parathyroid adenoma was identified and excised, with no macroscopic signs of malignancy. Discussion and conclusion: Hyper functioning parathyroid giant adenoma can present with typical symptoms of hypercalcemic crisis: ECG alterations, kidney failure, emotional lability, confusion, delirium, psychosis, asthenia, epilepsy. Elective treatment is the excission. The surgical technique contemplates neck exploration and to ensure the finding of the adenoma, previously identified with imaging tests. It is necessary to measure intra-operative iPTH assay.
Hyperfunctioning Parathyroid Giant Adenoma
SPERLONGANO, Pasquale;ACCARDO, Marina;MAZZONE, Adriano;Manfredi, C;Sperlongano, S;GUBITOSI, Adelmo
2015
Abstract
Purpose: The objective of this paper is to report the management and treatment of a 47-year-old patient admitted with multiple problems including asthenia, nausea and bradycardia, and was diagnosed with a giant parathyroid adenoma. Case report: A 47-year-old man was admitted to the Department of General Surgery for acute and worsening asthenia, nausea and bradycardia. Blood tests showed hypercalcemia, hypophosporemia, very high serum parathormone level, so that he was diagnosed with primary hyperparathyroidism. Cervical ultrasonography and scintigraphy with technetium 99 mTc Methoxyisobutylisonitrile (99 mTc-MIBI) showed the presence of positive nodule at the isthmus of the thyroid gland. The patient underwent neck exploration. Intra-operative iPTH essay was measured. A giant parathyroid adenoma was identified and excised, with no macroscopic signs of malignancy. Discussion and conclusion: Hyper functioning parathyroid giant adenoma can present with typical symptoms of hypercalcemic crisis: ECG alterations, kidney failure, emotional lability, confusion, delirium, psychosis, asthenia, epilepsy. Elective treatment is the excission. The surgical technique contemplates neck exploration and to ensure the finding of the adenoma, previously identified with imaging tests. It is necessary to measure intra-operative iPTH assay.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
