Mahmood Saad Bin Zafar, Jamal Aisha, Mushtaq Zain, Masood Muhammad Q
Medicine, Aga Khan University Hospital, Karachi, PAK.
Internal Medicine, Aga Khan University Hospital, Karachi, PAK.
Cureus. 2023 Dec 31;15(12):e51404. doi: 10.7759/cureus.51404. eCollection 2023 Dec.
Ectopic parathyroid tumors are uncommon, accounting for only 6% of parathyroid adenomas, and even fewer cases are attributed to parathyroid carcinomas. While ectopic parathyroid carcinoma in the anterior mediastinum is a rare condition, the occurrence of recurrent skeletal fractures in the presence of mild hypercalcemia is even rarer. In this report, we present the case of a 52-year-old man with a medical history of hypertension, chronic kidney disease, and a previous right-sided intertrochanteric fracture of the femur one year earlier. He presented to the emergency room with left-sided hip pain and shortness of breath due to volume overload. Laboratory tests revealed mild hypercalcemia and hyperparathyroidism, with normal vitamin D levels. An X-ray showed a left neck of femur fracture. Further evaluation with a three-phase skeletal scintigraphy indicated the presence of metabolic bone disease. A contrast-enhanced computed tomography of the chest revealed a solitary soft tissue nodule in the anterior mediastinum, representing an ectopic parathyroid adenoma. The lesion was successfully removed using video-assisted thoracic surgery, and the histopathological analysis confirmed the diagnosis of parathyroid carcinoma. The combination of mild hypercalcemia and recurrent fractures is an unusual presentation of ectopic parathyroid carcinoma, underscoring the importance of considering this condition as a potential cause in similar cases to ensure timely and appropriate treatment.
异位甲状旁腺肿瘤并不常见，仅占甲状旁腺腺瘤的6%，而归因于甲状旁腺癌的病例更少。虽然前纵隔异位甲状旁腺癌是一种罕见疾病，但在轻度高钙血症情况下发生反复性骨骼骨折的情况更为罕见。在本报告中，我们介绍了一名52岁男性的病例，他有高血压、慢性肾病病史，一年前曾发生右股骨转子间骨折。他因容量负荷过重出现左侧髋部疼痛和呼吸急促而就诊于急诊室。实验室检查显示轻度高钙血症和甲状旁腺功能亢进，维生素D水平正常。X线显示左股骨颈骨折。三相骨闪烁显像进一步评估提示存在代谢性骨病。胸部增强计算机断层扫描显示前纵隔有一个孤立的软组织结节，为异位甲状旁腺腺瘤。该病变通过电视辅助胸腔镜手术成功切除，组织病理学分析确诊为甲状旁腺癌。轻度高钙血症和反复骨折的组合是异位甲状旁腺癌的一种不寻常表现，强调了在类似病例中考虑这种疾病作为潜在病因以确保及时和适当治疗的重要性。
