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Symptomatic Primary Hyperparathyroidism in a Woman in Remission from Breast Cancer: A Case Report from Antananarivo, Madagascar

Received: 7 July 2022    Accepted: 25 July 2022    Published: 4 August 2022
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Abstract

The occurrence of hypercalcemia in a person with cancer always raises concerns about hypercalcemia of malignancy. A well-conducted diagnostic approach can rule out this possibility and find primary hyperparathyroidism, the other most common cause of hypercalcemia. Few cases of primary hyperparathyroidism have been reported in Madagascar. Our aim is to report a case of it by discussing the circumstances of discovery and its therapeutic management. We report a case of 56 years- old patient, with treated breast cancer in remission, hospitalized for symptomatic hypercalcemia at 3.14 mmol/l. Her serum intact PTH level was elevated to 270 ng/ml and images in favor of osteitis fibrosa cystica were present in the spine and pelvis. Cervical ultrasonography could not locate the pathological parathyroids. Cervico-thoracic CT scan revealed two bilateral para-esophageal parathyroid nodules which were removed by bilateral neck exploration parathyroidectomy and for which the anatomo-pathological examination was in favour of an adenoma. The postoperative course was simple. This observation illustrates that hypercalcemia in subjects with active cancer or cancer in remission is not always related to metastasis but may, indeed, be related to primary hyperparathyroidism. Its curative treatment is based on surgical removal of the pathological parathyroid(s).

Published in International Journal of Diabetes and Endocrinology (Volume 7, Issue 3)
DOI 10.11648/j.ijde.20220703.12
Page(s) 54-58
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

CT Scan, Hypercalcemia, Osteitis Fibrosa Cystica, Parathyroidectomy, Primary Hyperparathyroidism, Scintigraphy

References
[1] Tonon CR, Silva TAAL, Pereira FWL, Queiroz DAR, Junior ELF, Martins D et al. (2022), A review of current clinical concepts in the pathophysiology, etiology, diagnosis, and management of hypercalcemia. Med SciMonit, 28, e935821.
[2] Endres DB. (2012). Investigation of hypercalcemia. ClinBiochem, 45 (12): 954-963.
[3] Grill V, Martin TJ. (2000). Hypercalcemia of malignancy. Rev Endocr Metab Disord, 1, 253– 263.
[4] Fraser WD. (2009). Hyperparathyroidism. Lancet, 374, 148-158.
[5] Melton L. (1991). Epidemiology of primary hyperparathyroidism. J Bone Miner Res, 6 (2): S25-S30.
[6] Maier JD, Levine SN. (2015). Hypercalcemia in the intensive care unit: A review of pathophysiology, diagnosis, and modern therapy. J Intensive Care Med, 30 (5): 235-252.
[7] Mirrakhimov AE. (2015). Hypercalcemia of Malignancy: An Update on Pathogenesis and Management. N Am J Med Sci, 7 (11): 483-493.
[8] Walker MD, Silverberg SJ. (2018). Primary hyperparathyroidism. Nat Rev Endocrinol, 14, 115-125.
[9] Kingsley UI, Agu CE, Nwosu TF (2017). Critical review of hypercalcemia. J Med Allied Sci, 7 (1): 03-08.
[10] Fierabracci P, Pinchera A, Miccoli P, Conte PF, Vignali E, Zaccagnini M et al.(2001). Increased prevalence of primary hyperparathyroidism in treated breast cancer. J Endocrinol Invest, 24 (5): 315-320.
[11] Andriantsoa J, Andriamanalina T, Ramamonjy A, Ranivosoarivony M, GizyRatiambahoaka D, Ramahandridona G et al. (2008). Interest of scintigraphic imaging in Madagascar for the diagnosis of ectopic parathyroid adenoma, about one case. Intérêt de l’imagerie scintigraphique, à Madagascar, dans le diagnostic de l’adénome parathyroïdien ectopique – à propos d’un cas. Medecine Nucleaire. Imagerie Fonctionnelle et Metabolique, 32 (11): 568-572.
[12] Pallan S, Khan A. (2011). Primary hyperparathyroidism: Update on presentation, diagnosis, and management in primary care. Can Fam Physician, 57 (2): 184-189.
[13] Marcocci C, Cetani F. (2011). Clinical practice. Primary hyperparathyroidism. N Engl J Med, 365 (25): 2389-2397.
[14] Gardner EC, Hersh T. (1981). Primary hyperparathyroidism and the gastrointestinal tract. South Med J, 74, 197-199.
[15] Parfitt AM. (1976). The action of parathyroid hormone on bone. Relation to bone remodelling and turnover, calcium homeostasis and metabolic bone disease. Part III. Metabolism, 25, 1033-1069.
[16] Bringhurst FR, Demay MB, Kronenberg HM. Hormones and Disorders of Mineral Metabolism. In:Melmed S, Polonsky KS, Larsen PR, Kronenberg HM, dir. Williams textbook of endocrinology 13th edition. Philadelphia:Elsevier; 2016. p. 1263-322.
[17] Wermers RA, Khosla S, Atkinson EJ, Achenbach SJ, Oberg AL, Grant CS et al. (2006). Incidence of primary hyperparathyroidism in Rochester, Minnesota, 1993-2001: an update on the changing epidemiology of the disease. J Bone Miner Res, 21 (1): 171-177.
[18] Silverberg SJ, Shane E, Jacobs TP, Siris E, Bilezikian JP. A (1999). 10-year prospective study of primary hyperparathyroidism with or without parathyroid surgery. N Engl J Med, 341, 1249-1255.
[19] Aoki T. (1975). The effect of menopause on serum levels of calcium and inorganic phosphorus. Folia endocrinoljap, 51 (6): 556-560.
[20] Bilezikian JP, Brandi ML, Eastell R, Silverberg SJ, Udelsman R, Marcocci C et al. (2014). Guidelines for the management of asymptomatic primary hyperparathyroidism: summary statement from the fourth international workshop. J Clin Endoc Metabolism, 99 (10): 3561-3569.
[21] Wilhelm SM, Wang TS, Ruan DT, Lee JA, Asa SL, Duh QY et al. (2016). The American Association of Endocrine Surgeons Guidelines for definitive management of primary hyperparathyroidism. JAMA Surg, 151, 959-968.
[22] Moka D, Voth E, Dietlein M, Larena-Avellaneda A, Schicha H. (2000). Technetium 99m-MIBI-SPECT: a highly sensitive diagnostic tool for localization of parathyroid adenomas. Surgery, 128, 29-35.
[23] RudaJM, Hollenbeak CS, Stack Jr BC. (2005). A systematic review of the diagnosis and treatment of primary hyperparathyroidism from 1995 to 2003. Otolaryngol Head Neck Surg, 132 (3): 359-372.
[24] Kuzminski SJ, Sosa JA, Hoang JK. (2018). Update in Parathyroid Imaging. Magn. Reson. Imaging Clin N Am, 26, 151-166.
[25] Mihai R., Simon D, Hellman P. (2009). Imaging for primary hyperparathyroidism — an evidence-based analysis. Langenbecks Arch. Chir, 394, 765-784.
[26] Piciucchi S, Barone D, Gavelli G, Dubini A, Oboldi D, Matteuci F. (2012). Primary Hyperparathyroidism: Imaging to Pathology. J Clin Imaging Sci, 2, 59.
[27] Hoang JK, Reiman RE, NguyenGB, Januzis N, Chin BB, Lowry C et al. (2015). Lifetime attributable risk of cancer from radiation exposure during parathyroid imaging: comparison of 4D CT and parathyroid scintigraphy. Am J Roentgenol, 204, W579-85.
[28] Eastell R, Brandi ML, Costa AG, D'Amour P, Shoback DM, Thakker RV. (2014). Diagnosis of asymptomatic primary hyperparathyroidism: proceedings of the Fourth International Workshop. J Clin Endocrinol Metab, 99 (10): 3570-3579.
[29] Peacock M., Bilezikian J. P., Bolognese M. A., Borofsky M., Scumpia S., Sterling L. R. (2011). CinacalcetHCl reduces hypercalcemia in primary hyperparathyroidism across a wide spectrum of disease severity. J Clin Endocrinol Metab, 96, E9–18.
[30] Harrison B, Triponez F. Intraoperative adjuncts in surgery for primary hyperparathyroidism. Langenbecks Arch Surg. 2009; 394 (5): 799-809.
[31] Henry JF, Sebag F, Cherenko M, Ippolito G, Taieb D, Vaillant J. (2008). Endoscopic parathyroidectomy: why and when? World J Surg, 32 (11): 2509-2515.
[32] Selberherr A, Scheuba C, Riss P, Niederle B. (2015). Postoperative hypoparathyroidism after thyroidectomy: efficient and cost-effective diagnosis and treatment. Surgery, 57, 349-353.
[33] Marcocci C, Bollerslev J, Khan AA, Shoback DM. (2014). Medical management of primary hyperparathyroidism: proceedings of the fourth international workshop on the management of asymptomatic primary hyperparathyroidism. J Clin Endocrinol Metab, 99 (10): 3607-3618.
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  • APA Style

    Rija Eric Raherison, Sitraka Angelo Raharinavalona, Tsikinirina Valisoa Randrianomanana, Thierry Razanamparany, Miora Maeva Arielle Andrianiaina, et al. (2022). Symptomatic Primary Hyperparathyroidism in a Woman in Remission from Breast Cancer: A Case Report from Antananarivo, Madagascar. International Journal of Diabetes and Endocrinology, 7(3), 54-58. https://doi.org/10.11648/j.ijde.20220703.12

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    ACS Style

    Rija Eric Raherison; Sitraka Angelo Raharinavalona; Tsikinirina Valisoa Randrianomanana; Thierry Razanamparany; Miora Maeva Arielle Andrianiaina, et al. Symptomatic Primary Hyperparathyroidism in a Woman in Remission from Breast Cancer: A Case Report from Antananarivo, Madagascar. Int. J. Diabetes Endocrinol. 2022, 7(3), 54-58. doi: 10.11648/j.ijde.20220703.12

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    AMA Style

    Rija Eric Raherison, Sitraka Angelo Raharinavalona, Tsikinirina Valisoa Randrianomanana, Thierry Razanamparany, Miora Maeva Arielle Andrianiaina, et al. Symptomatic Primary Hyperparathyroidism in a Woman in Remission from Breast Cancer: A Case Report from Antananarivo, Madagascar. Int J Diabetes Endocrinol. 2022;7(3):54-58. doi: 10.11648/j.ijde.20220703.12

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  • @article{10.11648/j.ijde.20220703.12,
      author = {Rija Eric Raherison and Sitraka Angelo Raharinavalona and Tsikinirina Valisoa Randrianomanana and Thierry Razanamparany and Miora Maeva Arielle Andrianiaina and Radonirina Lazasoa Andrianasolo and Andrianirina Dave Patrick Rakotomalala},
      title = {Symptomatic Primary Hyperparathyroidism in a Woman in Remission from Breast Cancer: A Case Report from Antananarivo, Madagascar},
      journal = {International Journal of Diabetes and Endocrinology},
      volume = {7},
      number = {3},
      pages = {54-58},
      doi = {10.11648/j.ijde.20220703.12},
      url = {https://doi.org/10.11648/j.ijde.20220703.12},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijde.20220703.12},
      abstract = {The occurrence of hypercalcemia in a person with cancer always raises concerns about hypercalcemia of malignancy. A well-conducted diagnostic approach can rule out this possibility and find primary hyperparathyroidism, the other most common cause of hypercalcemia. Few cases of primary hyperparathyroidism have been reported in Madagascar. Our aim is to report a case of it by discussing the circumstances of discovery and its therapeutic management. We report a case of 56 years- old patient, with treated breast cancer in remission, hospitalized for symptomatic hypercalcemia at 3.14 mmol/l. Her serum intact PTH level was elevated to 270 ng/ml and images in favor of osteitis fibrosa cystica were present in the spine and pelvis. Cervical ultrasonography could not locate the pathological parathyroids. Cervico-thoracic CT scan revealed two bilateral para-esophageal parathyroid nodules which were removed by bilateral neck exploration parathyroidectomy and for which the anatomo-pathological examination was in favour of an adenoma. The postoperative course was simple. This observation illustrates that hypercalcemia in subjects with active cancer or cancer in remission is not always related to metastasis but may, indeed, be related to primary hyperparathyroidism. Its curative treatment is based on surgical removal of the pathological parathyroid(s).},
     year = {2022}
    }
    

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    T1  - Symptomatic Primary Hyperparathyroidism in a Woman in Remission from Breast Cancer: A Case Report from Antananarivo, Madagascar
    AU  - Rija Eric Raherison
    AU  - Sitraka Angelo Raharinavalona
    AU  - Tsikinirina Valisoa Randrianomanana
    AU  - Thierry Razanamparany
    AU  - Miora Maeva Arielle Andrianiaina
    AU  - Radonirina Lazasoa Andrianasolo
    AU  - Andrianirina Dave Patrick Rakotomalala
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    T2  - International Journal of Diabetes and Endocrinology
    JF  - International Journal of Diabetes and Endocrinology
    JO  - International Journal of Diabetes and Endocrinology
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    PB  - Science Publishing Group
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    AB  - The occurrence of hypercalcemia in a person with cancer always raises concerns about hypercalcemia of malignancy. A well-conducted diagnostic approach can rule out this possibility and find primary hyperparathyroidism, the other most common cause of hypercalcemia. Few cases of primary hyperparathyroidism have been reported in Madagascar. Our aim is to report a case of it by discussing the circumstances of discovery and its therapeutic management. We report a case of 56 years- old patient, with treated breast cancer in remission, hospitalized for symptomatic hypercalcemia at 3.14 mmol/l. Her serum intact PTH level was elevated to 270 ng/ml and images in favor of osteitis fibrosa cystica were present in the spine and pelvis. Cervical ultrasonography could not locate the pathological parathyroids. Cervico-thoracic CT scan revealed two bilateral para-esophageal parathyroid nodules which were removed by bilateral neck exploration parathyroidectomy and for which the anatomo-pathological examination was in favour of an adenoma. The postoperative course was simple. This observation illustrates that hypercalcemia in subjects with active cancer or cancer in remission is not always related to metastasis but may, indeed, be related to primary hyperparathyroidism. Its curative treatment is based on surgical removal of the pathological parathyroid(s).
    VL  - 7
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Author Information
  • Faculty of Medicine, University of Antananarivo, Antananarivo, Madagascar

  • Faculty of Medicine, University of Antananarivo, Antananarivo, Madagascar

  • Faculty of Medicine, University of Antananarivo, Antananarivo, Madagascar

  • Faculty of Medicine, University of Antananarivo, Antananarivo, Madagascar

  • Faculty of Medicine, University of Antananarivo, Antananarivo, Madagascar

  • Faculty of Medicine, University of Antananarivo, Antananarivo, Madagascar

  • Faculty of Medicine, University of Antananarivo, Antananarivo, Madagascar

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