Departments of Endocrinology, Christian Medical College, Vellore, 632004, India.
Departments of Neurology, Christian Medical College, Vellore, 632004, India.
Endocrine. 2024 Dec;86(3):937-942. doi: 10.1007/s12020-024-04041-6. Epub 2024 Sep 18.
BACKGROUND/OBJECTIVE: Primary hyperparathyroidism (PHPT) may be asymptomatic or present with renal calculi, secondary osteoporosis, fractures and neuropsychiatric manifestations. Posterior reversible encephalopathy syndrome (PRES) and parkinsonism are atypical manifestations that may be rarely associated with PHPT. We report two patients who presented with the conditions mentioned above.
The first patient involved a 38-year-old woman who presented with diminution of vision, seizures, altered behavior and hypertension over eight months. An MRI of the brain done had shown vasogenic edema involving the parieto-occipital regions, suggestive of PRES. A metabolic screen revealed PTH-dependent hypercalcemia that was localized to the left inferior parathyroid gland. Following focused parathyroidectomy, there was improvement in sensorium, vision and normalization of blood pressure. The second patient was of a 74-year-old man who presented with progressive extrapyramidal symptoms of gait abnormalities and rigidity since the past eight months. He was initiated on Selegeline and Levodopa for the same purpose, and subsequently reported minimal improvement in symptoms. Investigations revealed PHPT associated with a right inferior parathyroid adenoma. Within two weeks following surgery, there was an improvement in rigidity and gait and he was able to ambulate without support.
PRES has been reported to occur in the context of preeclampsia, hypertension, infection, sepsis and autoimmune conditions. PRES associated with hypercalcemia is rarely reported. While extra-pyramidally related manifestations are described in hypoparathyroidism, PHPT related parkinsonism is not commonly encountered. Identifying the underlying aetiology and initiation of corrective measures may lead to amelioration of patient symptomatology.
The occurrence of PRES and parkinsonism is rare in primary hyperparathyroidism; the two patients described above highlight the importance of screening for hypercalcemia in the setting of neurological manifestations.
背景/目的：原发性甲状旁腺功能亢进症（PHPT）可无症状，或表现为肾结石、继发性骨质疏松症、骨折和神经精神表现。后部可逆性脑病综合征（PRES）和帕金森病是不典型表现，可能很少与 PHPT 相关。我们报告了两例具有上述表现的患者。
第一例患者为 38 岁女性，表现为视力减退、癫痫发作、行为改变和 8 个月高血压。脑部 MRI 显示涉及顶枕叶的血管源性水肿，提示 PRES。代谢筛查显示 PTH 依赖性高钙血症，定位于左下甲状旁腺。在进行针对性甲状旁腺切除术之后，患者的意识、视力得到改善，血压恢复正常。第二例患者为 74 岁男性，表现为过去 8 个月进行性锥体外系症状，包括步态异常和僵硬。他开始接受司来吉兰和左旋多巴治疗，症状随后略有改善。检查发现 PHPT 与右下甲状旁腺腺瘤相关。在手术后两周内，僵硬和步态得到改善，患者无需支撑即可行走。
PRES 已在子痫前期、高血压、感染、败血症和自身免疫性疾病中报告发生。与高钙血症相关的 PRES 很少见。虽然甲状旁腺功能减退症描述了与锥体外系相关的表现，但 PHPT 相关的帕金森病并不常见。确定潜在病因并采取纠正措施可能会改善患者的症状。
原发性甲状旁腺功能亢进症中 PRES 和帕金森病的发生罕见；上述两例患者强调了在出现神经表现时筛查高钙血症的重要性。
