title: Normocalcemic primary hyperparathyroidism: long-term follow-up associated with multiple adenomas.
abstract: Normocalcemic primary hyperparathyroidism (NPHPT) is a condition characterized by elevation of the parathyroid hormone (PTH) in the presence of normal serum calcium and the absence of secondary causes. The case described illustrates the long-term follow-up of a postmenopausal woman with NPHPT patient who progressed with multiple adenomas. This case reports a 77-year-old female who has chronic generalized pain and osteoporosis. Her initial serum PTH was 105 pg/mL, with total serum calcium of 9.6 mg/dL, albumin 4.79 g/dL, phosphorus 2.8 mg/dL, and 25OHD after supplementation was 34.6 ng/mL. The bone densitometry (BMD) results were as follows: lumbar spine: T-score -3.0, femoral neck: T-score -2.6 and distal radius: -4.2. Other causes of secondary hyperparathyroidism were ruled out and cervical ultrasound and Tc-99-Sestamibi scan were negative. She used oral alendronate and three infusions of zoledronic acid for treatment of osteoporosis. In the 10th year of follow-up, after successive negative cervical imaging, ultrasound showed a nodule suggestive of an enlarged right inferior parathyroid gland. PTH levels in fluid which was obtained during fine-needle aspiration (FNA) were over 5,000 pg/mL and a Sestamibi scan was negative. The patient underwent parathyroidectomy, and a histological examination confirmed parathyroid adenoma. Post-operatively serum PTH remained elevated in the presence of normal serum calcium levels. A follow-up cervical ultrasound showed a new solid nodule suggestive of an enlarged right superior parathyroid gland. PTH levels in the aspiration fluid were remarkably high. A second parathyroidectomy was performed, with the excision of a histologically confirmed parathyroid adenoma. In conclusion, this is an unusual presentation of NPHPT and highlights the long-term complications.
authors.affiliation: Division of Endocrinology, Diabetes and Bone Diseases, Agamenon Magalhaes Hospital.
authors.forename: Larissa
authors.initials: L
authors.lastname: Pimentel
authors.affiliation: Division of Endocrinology, Diabetes and Bone Diseases, Agamenon Magalhaes Hospital.
authors.forename: Sirley
authors.initials: S
authors.lastname: Portela
authors.affiliation: Division of Endocrinology, Diabetes and Bone Diseases, Agamenon Magalhaes Hospital.
authors.forename: Alyne
authors.initials: A
authors.lastname: Loureiro
authors.affiliation: Division of Endocrinology, Diabetes and Bone Diseases, Agamenon Magalhaes Hospital.
authors.forename: Francisco
authors.initials: F
authors.lastname: Bandeira
mesh_terms: D000236:Adenoma / Q000473:pathology / Q000601:surgery*; D000368:Aged; D015519:Bone Density; D002118:Calcium / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000097:blood / Q000150:complications*; D008134:Long-Term Care; D010281:Parathyroid Hormone / Q000097:blood; D010282:Parathyroid Neoplasms / Q000150:complications* / Q000473:pathology / Q000601:surgery; D016105:Parathyroidectomy; D012709:Serum Albumin / Q000032:analysis
chemical_list: D010281:Parathyroid Hormone; D012709:Serum Albumin; D002118:Calcium