Journal of the Formosan Medical Association
Volume 106, Issue 2, Supplement , Pages S13-S16, 2007

Benign Parathyroid Adenoma Presenting with Unusual Parathyroid Crisis, Anemia and Myelofibrosis

  • Shu-Chuan Huang

      Affiliations

    • Division of Endocrinology and Metabolism, Department of Internal Medicine, Taoyuan Veterans Hospital, Taoyuan, Taiwan
    • Division of Endocrinology and Metabolism, Department of Internal Medicine, Taiwan
    • ,
  • Vin-Cent Wu

      Affiliations

    • Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
    • ,
  • Guan Chou

      Affiliations

    • Department of Pathology, Taichung Veterans General Hospital, Taichung, Taiwan
    • ,
  • Tzu-Yu Huang

      Affiliations

    • Department of Pathology, Taichung Veterans General Hospital, Taichung, Taiwan
    • ,
  • Shih-Yi Lin

      Affiliations

    • Division of Endocrinology and Metabolism, Department of Internal Medicine, Taiwan
    • Corresponding Author InformationCorrespondence to: Dr Shih-Yi Lin Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, 160, Section 3, Chung Kang Road, Taichung 407, Taiwan
    • ,
  • Wayne Huey-Herng Sheu

      Affiliations

    • Division of Endocrinology and Metabolism, Department of Internal Medicine, Taiwan

Received 19 December 2005; received in revised form 25 January 2006; accepted 4 April 2006.

Article Outline

Although the clinical symptoms of patients with benign parathyroid adenoma are usually nonspecific and benign, a malignant presentation of the benign disease may sometimes occur. Here, we report a case of a 58-year-old woman who presented with aggravated sacrum pain, general malaise, and polydipsia. Initial laboratory findings revealed hypercalcemia, normocytic anemia, and impaired renal function. Acute hyper-calcemic crisis manifested and primary hyperparathyroidism was diagnosed together with myelofibrosis on account of the result of bone marrow biopsy. Excision of a parathyroid adenoma was performed, and the anemia and bone marker regressed later. These findings suggested that benign parathyroid adenoma may mimic the clinical presentation of parathyroid carcinoma, releasing excess parathyroid hormone and resulting in hyperparathyroid crisis. In addition, primary hyperparathyroidism can be associated with anemia and myelofibrosis. [J Formos Med Assoc 2007;106(2 Suppl):S13-S16]

Key Words:  anemia , hyperparathyroidism , myelofibrosis

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References 

  1. Fitzpatrick LA , Bilezikian JP . Acute primary hyperparathyroidism . Am J Med . 1987;82:275–282
  2. Falko JM , Guy JT , Smith RE , et al.   Primary hyperparathyroidism and anemia . Arch Intern Med . 1976;136:887–889
  3. Bayat-Mokhtari F , Palmieri GM , Moinuddin M , et al.   Parathyroid storm . Arch Intern Med . 1980;140:1092–1095
  4. Maselly MJ , Lawrence AM , Brooks M , et al.   Hyper-parathyroid crisis. Successful treatment of ten comatose patients . Surgery . 1981;90:741–746
  5. Wynne AG , van Heerden J , Carney JA , et al.   Parathyroid carcinoma: clinical and pathologic features in 43 patients . Medicine (Baltimore) . 1992;71:197–205
  6. Nussbaum SR , Zahradnik RJ , Lavigne JR , et al.   Highly sensitive two-site immunoradiometric assay of parathyrin, and its clinical utility in evaluating patients with hypercalcemia . Clin Chem . 1987;33:1364–1367
  7. Mittendorf EA , McHenry CR . Parathyroid carcinoma . J Surg Oncol . 2005;89:136–142
  8. Levin KE , Galante M , Clark OH . Parathyroid carcinoma versus parathyroid adenoma in patients with profound hypercalcemia . Surgery . 1987;101:647–660
  9. Fleischer J , Becker C , Hamele-Bena D , et al.   Oxyphil parathyroid adenoma: a malignant presentation of a benign disease . J Clin Endocrinol Metab . 2004;89:5948–5951
  10. Boxer M , Ellman L , Geller R , et al.   Anemia in primary hyper-parathyroidism . Arch Intern Med . 1977;137:588–593
  11. Kotzmann H , Abela C , Heindl J , et al.   Effect of successful parathyroidectomy on hematopoietic progenitor cells and parameters of red blood cells in patients with primary hyperparathyroidism . Horm Metab Res . 1997;29:387–392
  12. Meytes D , Bogin E , Ma A , et al.   Effect of parathyroid hormone on erythropoiesis . J Clin Invest . 1981;67:1263–1269
  13. Delwiche F , Garrity MJ , Powell JS , et al.   High levels of the circulating form of parathyroid hormone do not inhibit in vitro erythropoiesis . J Lab Clin Med . 1983;102:613–620
  14. Mallette LE , Bilezikian JP , Heath DA , et al.   Primary hyper-parathyroidism: clinical and biochemical features . Medicine (Baltimore) . 1974;53:127–146
  15. Zingraff J , Drueke T , Marie P , et al.   Anemia and secondary hyperparathyroidism . Arch Intern Med . 1978;138:1650–1652
  16. Rao DS , Shih MS , Mohini R . Effect of serum parathyoroid hormone and bone marrow fibrosis on the response to erythropoietin in uremia . N Engl J Med . 1993;328:171–175
  17. Duarte ME , Carvalho EF , Cruz EA , et al.   Cytokine accumulation in osteitis fibrosa of renal osteodystrophy . Braz J Med Biol Res . 2002;35:25–29
  18. Lotinun S , Sibonga JD , Turner RT . Evidence that the cells responsible for marrow fibrosis in a rat model for hyper-parathyroidism are preosteoblasts . Endocrinology . 2005;146:4074–4081
  19. Pun KK , Ho PW . Identification and characterization of parathyroid hormone receptors on dog kidney, human kidney, chick bone and human dermal fibroblast. A comparative study of functional and structural properties . Biochem J . 1989;259:785–789
  20. Mallette LE . Anemia in hypercalcemic hyperparathyroidism. Renewed interest in an old observation . Arch Intern Med . 1977;137:572–573
  21. Kumbasar B , Taylan I , Kazancioglu R , et al.   Myelofibrosis secondary to hyper-parathyroidism . Exp Clin Endocrinol Diabetes . 2004;112:127–130

PII: S0929-6646(09)60346-6

doi:10.1016/S0929-6646(09)60346-6

Journal of the Formosan Medical Association
Volume 106, Issue 2, Supplement , Pages S13-S16, 2007

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