|Year : 2014 | Volume
| Issue : 3 | Page : 183-184
Helpless he came to us, now the hopeless go to him: A case of parathyroid adenoma
Nagarjunakonda Venkata Sundarachary1, Amalakanti Sridhar2
1 Department of Neurology, Guntur Medical College, Guntur, Andhra Pradesh, India
2 Department of General Medicine, Guntur Medical College, Guntur, Andhra Pradesh, India
|Date of Web Publication||17-Sep-2014|
FF-5, PG Hostel, Government General Hospital, Guntur - 522 001, Andhra Pradesh
Source of Support: None, Conflict of Interest: None
Endocrine tumors are known for their varied presentations. Parathyroid adenomas (PAs) are tumors of endocrine origin and are rarely detected clinically. We report a case of a young male with PA with unusual features.
Keywords: Endocrine tumor, normocalcemic parathyroid adenoma, parathyroid adenoma
|How to cite this article:|
Sundarachary NV, Sridhar A. Helpless he came to us, now the hopeless go to him: A case of parathyroid adenoma. J NTR Univ Health Sci 2014;3:183-4
|How to cite this URL:|
Sundarachary NV, Sridhar A. Helpless he came to us, now the hopeless go to him: A case of parathyroid adenoma. J NTR Univ Health Sci [serial online] 2014 [cited 2020 Apr 1];3:183-4. Available from: http://www.jdrntruhs.org/text.asp?2014/3/3/183/140940
| Introduction|| |
Tumors of the endocrine system can present with the manifestations involving many organs.  It is often difficult to diagnose these conditions. Among these tumors, those involving the parathyroid gland are very rare and elude diagnosis for a long time. Parathyroid adenoma (PA) is the most common cause of primary hyperparathyroidism (85%), other rare etiologies being the parathyroid hyperplasia from familial syndromes and parathyroid cancer.  We report a case of a young male presenting with intriguing symptoms due to a PA.
| Case report|| |
A 16-year-old male came to the neurology outpatient department for a certificate of invalidation. He was suffering from weakness of all the four limbs for the last 1 year and was bed bound. He suffered from painful knee, ankle, hip, shoulder, elbow, and wrist joints. This was associated with fixed flexion deformities at the wrist and ankle joints. Examination revealed proximal myopathic weakness and kyphoscoliosis with short stature. Blood investigations were normal including serum calcium and phosphorus. There was mild osteoporosis in the X-ray films. After deliberation, we obtained serum parathormone level. It was grossly elevated. Ultrasound neck revealed a mass in the inferior pole of the right thyroid gland. It was surgically excised, and histopathological examination showed features of a PA. The patient recovered from weakness and joint pains over a period of 1 month. The deformities [Figure 1] in the long bones are to be corrected by orthopedic surgery. Right now, he is working as a pastor in a church.
| Discussion|| |
The patient presented with quadriparesis and joint deformities, a combination that pointed to a metabolic disorder. Routine metabolic parameters especially serum electrolyte concentrations were normal. Review of literature helped to acquire specific investigations and the elevated parathormone level was found out. This directed the imaging for parathyroid gland. The myopathy and bony deformities can be explained by subclinical hypercalcemia or chronic compensated hypercalcemia.
Parathyroid adenoma is part of a spectrum of parathyroid proliferative disorder that includes parathyroid hyperplasia, PA, and parathyroid carcinoma.  Patients typically present with evidence of primary hyperparathyroidism with elevated serum calcium levels and elevated serum parathyroid hormone levels. Patients with primary hyperparathyroidism may present with clinical evidence of elevated serum calcium levels, which include nonspecific symptoms such as fatigue, pain, and weakness as well as polydipsia, polyuria, and nephrolithiasis.  Gastrointestinal symptoms include constipation, anorexia, nausea, and vomiting.  Extreme hypercalcemia can lead to cardiac arrhythmias, coma and death. These days most patients with hypercalcemia are discovered incidentally on routine work-up for other reasons.  PAs were present in some of the cases reported as normocalcemic hyperparathyroidism.  Our case is also in alignment with this presentation.
The uncommon constellation of symptoms in this case is an instruction for deeper analysis of each symptom and necessity of persistence in the evaluation of these manifestations. Clinicians may have to be acquainted with these presentations.
| Acknowledgment|| |
The authors would like to thank Department of General Surgery, Government General hospital, Guntur, Andhra Pradesh, India.
| References|| |
|1.||Pannett AA, Thakker RV. Multiple endocrine neoplasia type 1. Endocr Relat Cancer 1999;6:449-73. |
|2.||Chatterjee S, Ray U, Gupta S, Basu A. Concurrent parathyroid carcinoma and adenoma: A rare presentation of a rarer disease entity. Indian J Endocrinol Metab 2013;17:939-41. |
|3.||Shah VN, Bhadada SK, Bhansali A, Behera A, Mittal BR, Bhavin V. Influence of age and gender on presentation of symptomatic primary hyperparathyroidism. J Postgrad Med 2012;58:107-11. |
|4.||Abboud B, Daher R, Boujaoude J. Digestive manifestations of parathyroid disorders. World J Gastroenterol 2011;17:4063-6. |
|5.||Fang SH, Lal G. Parathyroid cancer. Endocr Pract 2011;17 Suppl 1:36-43. |
|6.||Wieneke JA, Smith A. Parathyroid adenoma. Head Neck Pathol 2008;2:305-8. |