A 28-year-old male from a rural area who was hospitalized at the Her Henríque nausea ANTena peso, Temuco Hospital in April 2002 for acute pancreatitis, preceded by anorexia and malaise.
Physical examination revealed cachexia and lacking signs.
Abdominal ultrasound showed double left kidney stones and in the laboratory highlighted: calcemia 15.1 mg/dL patient ́s physiologic condition, 1.2 mg/dL patient ́s lithiasis, alkaline manure (U/FA) 5.713.
At home, he added progressive muscle weakness and spontaneous fractures of the left hilum and bladder both, which posted him in bed, accepting to be hospitalized in July 2002.
On physical examination, displaced fractures and neck fractures were detected, and a 4 cm nodule was detected in the neck in relation to the left thyroid lobe, without appearance of adenopathies.
Laboratory tests are summarized in Table 1.
Radiography of long bones showed suggestive elements of osteitis fibrosa cystica and fractures in the proximal third of both forms.
A computed axial tomography of the neck showed a solid, hypodense, well-defined 3 cm long nodule, which displaced anteriorly to the lower pole of the left thyroid lobe.
Scintigraphy with 99m Tc Sestamibi was compatible with abnormal left parathyroid tissue.
1.
It was treated with saline associated with intravenous furosemide, inhalations of calcitonin and alendronate 10 mg/day for 7 days, due to the difficulty in maintaining the calcemia low 12 mg/dL.
With the clinical suspicion of parathyroid carcinoma, the patient underwent surgery, finding a parathyroid tumor of 4 per 2.3 cm, included in the left thyroid lobe.
It was not possible to identify the other parathyroid glands.
Parathyroid tumor and left thyroid lobe were removed in block.
Histology confirmed the diagnosis of parathyroid cancer by the presence of invasion and vascular blood.
Immunohistochemical expression of adenocarcinoma was negative and the ki 67 antigen expression in tumor cells was 5%.
The tumor showed an aneuploid pattern in flow cytometry.
1.
It is observed intense colitis, cortical bone loss and areas with appearance of cysts and brown tumors.
Displaced fracture of the distal third of the left hilum.
1.
Postoperatively, the patient developed severe osmotic bone syndrome, which resulted in nadir calcemia on day 8 and bacteremia on day 2.
Along with oral calcium and calcitriol, it was necessary to provide parenteral calcium at doses of 3-10 g/day for 5 weeks.
During 16 months of post-surgery follow-up, with oral intake of 3 to 4 g/day of elemental calcium associated with vitamin D, the patient has remained without symptoms of hypocalcemia, with calcemias between 7.5 mg/dL and dL.
Elevated alkaline phosphatase levels persist, but PTH levels remain elevated and intact remain slightly above normal levels, but with calcium levels.
Endomedullary nails were inserted into both cavities. This procedure failed due to bone characteristics.
After 14 months, the patient received kinesic rehabilitation, achieving the goal of achieving consolidation therapy.
The fractures consolidated spontaneously, but with significant deformity of the four limbs.
Currently, the patient receives support and has good functionality of the upper limbs.
