title: Life-threatening intrathyroidal parathyroid adenoma.
abstract: Acute primary hyperparathyroidism and parathyroid crisis are characterized by life-threatening hypercalcemia, a rare disorder. A 69-year-old female patient presented at our hospital's neurology clinic with weakness, nausea, vomiting, depression, and hypercalcemia. Treatment of hypercalcemia resulted in no improvement in neurological symptoms, indicating resistance to treatment. Thyroid ultrasonography and parathyroid scintigraphy revealed hypoechoic nodules in the right lobe, pieces of nodules in the left lobe, and high serum calcium and parathyroid hormone levels. After provision of intensive medical treatment including hydration, diuresis, and bisphosphonate infusion resulted in only minimal decrease in the calcium level, urgent surgical treatment was performed. Frozen biopsy of the right intrathyroidal giant parathyroid adenoma in the right lobe confirmed initial diagnosis of primary hyperparathyroidism. Based on the biopsy findings, right parathyroidectomy and right total and left subtotal thyroidectomy were performed. Histopathologic examination revealed a parathyroid adenoma localized inside large thyroid nodules. Review of the findings resulted in diagnosis of intrathyroidal parathyroid adenoma. Symptoms of hypercalcemia improved rapidly during the postoperative period.
authors.affiliation: Department of General Surgery, Antalya Training and Research Hospital Antalya.
authors.forename: Ugur
authors.initials: U
authors.lastname: Dogan
authors.affiliation: Department of General Surgery, Antalya Training and Research Hospital Antalya.
authors.forename: Umit
authors.initials: U
authors.lastname: Koc
authors.affiliation: Department of General Surgery, Antalya Training and Research Hospital Antalya.
authors.forename: Burhan
authors.initials: B
authors.lastname: Mayir
authors.affiliation: Department of General Surgery, Antalya Training and Research Hospital Antalya.
authors.forename: Mani
authors.initials: M
authors.lastname: Habibi
authors.affiliation: Eye Clinic, Antalya Training and Research Hospital Antalya.
authors.forename: Berna
authors.initials: B
authors.lastname: Dogan
authors.affiliation: Department of General Surgery, Antalya Training and Research Hospital Antalya.
authors.forename: Ismail
authors.initials: I
authors.lastname: Gomceli
authors.affiliation: Department of General Surgery, Antalya Training and Research Hospital Antalya.
authors.forename: Nurullah
authors.initials: N
authors.lastname: Bulbuller
keywords: Acute primary hyperparathyroidism; hypercalcemia; hyperplasia; intrathyroidal parathyroid adenoma; parathyroid crisis; parathyroidectomy