In 1993, a 73-year-old male was admitted to the internal medicine service with a provisional diagnosis of bone metastasis of unknown primary tumor.
He had lost 15 kg in 18 months and manifested anorexia, constipation, left thigh pain and elevated blood calcium, bilirubin and acid and alkaline phosphatase.
Bone scintigraphy showed multiple areas of greater uptake and osteoarthropathy, suggesting metastatic disease.
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The personal history of the patient offered nothing remarkable except having been operated for a maxillary tumor at the age of 18 (1938).
Histological diagnosis of this tumor was not available.
During admission, elevated levels of urinary parathyroid hormone and blood calcium were found.
Cervical ultrasound showed increased size of the right inferior parathyroid gland.
The patient underwent right hemithyroidectomy with excision of the enlarged parathyroid gland and ipsilateral gland; calcemia was immediately normalized.
Histopathology revealed carcinoma of the inferior parathyroid gland and hyperplasia of the superior parathyroid gland.
Two years later, the patient developed new bone pain and constipation with high levels of calcium and parathormone in the blood.
In a new intervention, hemithyroidectomy, left parathyroidectomy and thymectomy were performed.
Calcemia normalized but the patient died two years later due to unrelated causes.
