Journal of Endocrinological Investigation

, Volume 29, Issue 7, pp 641–644 | Cite as

Metastatic calcifications and severe hypercalcemia in a patient with parathyroid carcinoma

  • P. Aldivielso
  • J. ópez-Sánchez
  • A. Arrido
  • J. J. ánchez-Carrillo
Case Report

Abstract

Primary hyperparathyroidism is rarely produced by parathyroid carcinoma. We present the case of a 63-yr-old man who was admitted due to recent onset of constipation, weakness and progressive lethargy. At physical examination, a left cervical mass was palpated. Marked hypercalcemia (serum calcium 25 mg/dl) (6.22 mmol/l) complicated by renal insuficiency (serum creatinine 4.4 mg/dl) (388 μmol/l) was found, but both were unresponsive to conventional therapy and hemofiltration. Autopsy examination showed a carcinoma of the upper left parathyroid gland, multiple foci of metastatic calficications in the vessel walls and parenchyma of both lungs and kidneys, and the myocardium, which contributed to multi-organ failure and death. In addition to describing the clinical presentation, we review the mechanism of metastatic calcifications as well as the role of renal function and hyperphosphatemia, and the basis for therapy of hypercalcemic crisis.

Keywords

Metastatic calcification hypercalcemic crisis parathyroid carcinoma parathyroid crisis hyperparathyroidism 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Mittendorf EA, McHenry CR. Parathyroid carcinoma. J Surg Oncol 2005, 89: 136–42.PubMedCrossRefGoogle Scholar
  2. 2.
    Koea JB, Shaw JH. Parathyroid cancer: biology and management. Surg Oncol 1999, 8: 155–65.PubMedCrossRefGoogle Scholar
  3. 3.
    Schantz A, Castleman B. Parathyroid carcinoma. A study of 70 cases. Cancer 1973, 31: 600–5.PubMedCrossRefGoogle Scholar
  4. 4.
    Howell VM, Haven CJ, Kahnoski K, et al. HRPT2 mutations are associated with malignancy in sporadic parathyroid tumours. J Med Genet 2003, 40: 657–63.PubMedCentralPubMedCrossRefGoogle Scholar
  5. 5.
    Cetani F, Pardi E, Borsari S, et al. Genetic analyses of the HRPT2 gene in primary hyperparathyroidism: germline and somatic mutations in familial and sporadic parathyroid tumors. J Clin Endocrinol Metab 2004, 89: 5583–91.PubMedCrossRefGoogle Scholar
  6. 6.
    Shattuck TM, Valimaki S, Obara T, et al. Somatic and germline mutations of the HRPT2 gene in sporadic parathyroid carcinoma. N Engl J Med 2003, 349: 1722–9.PubMedCrossRefGoogle Scholar
  7. 7.
    Krebs LJ, Shattuck TM, Arnold A. HRPT2 mutational analysis of typical sporadic parathyroid adenomas. J Clin Endocrinol Metab 2005, 90: 5015–7.PubMedCrossRefGoogle Scholar
  8. 8.
    Sramek V, Novak I, Matejovic M, et al. Continuous venovenous hemodiafiltration (CVVHDF) with citrate anticoagulation in the treatment of a patient with acute renal failure, hypercalcemia, and thrombocytopenia. Intensive Care Med 1998, 24: 262–4.PubMedCrossRefGoogle Scholar
  9. 9.
    Mootz JR, Sagel SS, Roberts TH. Roentgenographic manifestations of pulmonary calcifications. A rare cause of respiratory failure in chronic renal disease. Radiology 1973, 107: 55–60.PubMedGoogle Scholar
  10. 10.
    Cohen AM, Maxon HR, Goldsmith RE, et al. Metastatic pulmonary calcification in primary hyperparathyroidism. Arch Intern Med 1977, 137: 520–2.PubMedCrossRefGoogle Scholar
  11. 11.
    Davidson RM, Dhekne RD, Moore WH, Butler DB. Metastatic calcification in a patient with malignant parathyroid carcinoma. Correlation of clinical, surgical, radiographic, and scintigraphic findings. Clin Nucl Med 1990, 15: 692–6.PubMedCrossRefGoogle Scholar
  12. 12.
    Hwang GJ, Lee JD, Park CY, Lim SK. Reversible extraskeletal uptake of bone scanning in primary hyperparathyroidism. J Nucl Med 1996, 37: 469–71.PubMedGoogle Scholar
  13. 13.
    Thompson AR, Fallon J, Nussbaum S. Evaluation of metastatic cardiac calcification in a model of chronic primary hyperparathyroidism. Surgery 1990, 108: 1047–51.PubMedGoogle Scholar
  14. 14.
    Stefenelli T, Abela C, Frank H, et al. Cardiac abnormalities in patients with primary hyperparathyroidism: implications for follow-up. J Clin Endocrinol Metab 1997, 82: 106–12.PubMedCrossRefGoogle Scholar
  15. 15.
    Seifert G. Heterotopic (extraosseous) calcification (calcinosis). Etiology, pathogenesis and clinical importance. Pathologe 1997, 18: 430–8.PubMedCrossRefGoogle Scholar
  16. 16.
    Amico S, Lucas P, Diebold MD, Liehn JC, Petit J, Valeyre J. Metastatic calcification in the thyroid gland demonstrated on bone scan in a patient with primary hyperparathyroidism. J Nucl Med 1986, 27: 373–6.PubMedGoogle Scholar
  17. 17.
    Glogar D, Zilcher H, Lintner F, Kern HG, Willvonseder R. Calcium induced necroses of cardiac muscle causing death in acute hyperparathyroidism (author’s transl). Dtsch Med Wochenschr 1980, 105: 307–10.PubMedCrossRefGoogle Scholar
  18. 18.
    Rayner HC, Hasking DJ. Hyperparathyroidism associated with severe hypercalcaemia and myocardial calcification despite minimal bone disease. Br Med J 1986, 293: 1277–8.CrossRefGoogle Scholar
  19. 19.
    Aso Y, Sato A, Tayama K, Takanashi K, Satoh H, Takemura Y. Parathyroid carcinoma with metastatic calcification identified by technetium-99m methylene diphosphonate scintigraphy. Intern Med 1996, 35: 392–5.PubMedCrossRefGoogle Scholar
  20. 20.
    Ishigaki H, Sutoh K, Fukushi A, et al. An autopsy case of parathyroid carcinoma with primary hyperparathyroidism. Gan No Rinsho 1988, 34: 1007–12.PubMedGoogle Scholar
  21. 21.
    Vernava AM 3rd, O’Neal LW, Palermo V. Lethal hyperparathyroid crisis: hazards of phosphate administration. Surgery 1987, 102: 941–8.PubMedGoogle Scholar
  22. 22.
    Kloeppel R, Luebke P, Mittag M, et al. Acute hypercalcemia of the heart (“bony heart”). J Comput Assist Tomogr 2001, 25: 407–11.PubMedCrossRefGoogle Scholar
  23. 23.
    Vainas IG, Tsilikas C, Grecu A, Pasaitu K, Stergiou I, Kortsaris AH. Metastatic parathyroid carcinoma (mPCa): natural history and treatment of a case. J Exp Clin Cancer Res 1997, 16: 429–32.PubMedGoogle Scholar
  24. 24.
    Rasmuson T, Kristoffersson A, Boquist L. Positive effect of radiotherapy and surgery on hormonally active pulmonary metastases of primary parathyroid carcinoma. Eur J Endocrinol 2000, 143: 749–54.PubMedCrossRefGoogle Scholar
  25. 25.
    Collins MT, Skarulis MC, Bilezikian JP, Silverberg SJ, Spiegel AM, Marx SJ. Treatment of hypercalcemia secondary to parathyroid carcinoma with a novel calcimimetic agent. J Clin Endocrinol Metab 1998, 83: 1083–8.PubMedCrossRefGoogle Scholar
  26. 26.
    Ziegler R. Hypercalcemic crisis. J Am Soc Nephrol 2001, 12 (Suppl 17): S3–9.PubMedGoogle Scholar
  27. 27.
    Aso Y, Sato A, Tayama K, Takanashi K, Satoh H, Takemura Y. Parathyroid carcinoma with metastatic calcification identified by technetium-99m methylene diphosphonate scintigraphy. Intern Med 1996, 35: 392–5.PubMedCrossRefGoogle Scholar

Copyright information

© Italian Society of Endocrinology (SIE) 2006

Authors and Affiliations

  • P. Aldivielso
    • 1
  • J. ópez-Sánchez
    • 2
  • A. Arrido
    • 1
  • J. J. ánchez-Carrillo
    • 2
  1. 1.Department of Internal MedicineHospital Virgen de la Victoria, Universidad de MálagaMálagaSpain
  2. 2.Department of PathologyHospital Virgen de la Victoria, Universidad de MálagaMálagaSpain

Personalised recommendations