Recurrent primary hyperparathyroidism : A diagnostic and management dilemma

Journal article

Wilkinson, Ben, Wan Muhamad Hatta, Sharifah Faradila, Garnham, Andrew Peter and Buch, Harit N.. (2021). Recurrent primary hyperparathyroidism : A diagnostic and management dilemma. Endocrinology, Diabetes and Metabolism Case Reports. 2021(1), pp. 1-5. https://doi.org/10.1530/EDM-20-0136
AuthorsWilkinson, Ben, Wan Muhamad Hatta, Sharifah Faradila, Garnham, Andrew Peter and Buch, Harit N.
Abstract

Primary hyperparathyroidism requires a surgical approach to achieve a long-term cure. However, post-surgical recurrence significantly complicates the management of this condition. A number of causes for recurrent disease are well understood and several diagnostic modalities exist to localise the culprit parathyroid adenoma although none of them is efficacious in localisation of the recurrent lesion. In this case report, we highlight a novel causative mechanism and describe a unique diagnostic sequence that enabled curative treatment to be delivered.

Learning points:

In the case described herein, we describe a novel location for a parathyroid adenoma causing recurrent PHPT. The case elucidates well the difficulties presented by such cases in terms of surgical planning and show the utility of PVS in such cases. Based on this case, we make the following recommendations:

Meticulous care must be taken to prevent seeding of adenomatous tissue during primary excision.

To consider the use of PVS in patients with discordant imaging in the setting of recurrent/persistent PHPT as a method to localise the causative adenoma.

Same day PVS and surgery is a viable option for patients who either represent an anaesthetic risk or who are extremely anxious about the prospect of two separate procedures.

Disordered calcium homeostasis is an important but forgotten cause of dysphagia which can be extremely debilitating for affected patients.

KeywordsAdult; Male; White; United Kingdom; Parathyroid; Mineral; Radiology; Rheumatology; Surgery
Year01 Jan 2021
JournalEndocrinology, Diabetes and Metabolism Case Reports
Journal citation2021 (1), pp. 1-5
PublisherBioScientifica Ltd.
ISSN2052-0573
Digital Object Identifier (DOI)https://doi.org/10.1530/EDM-20-0136
Web address (URL)https://edm.bioscientifica.com/view/journals/edm/2021/1/EDM20-0136.xml
Open accessPublished as non-open access
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Online27 Apr 2021
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Deposited15 Nov 2024
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© 2021 The authors

This work is licensed under a Creative Commons
Attribution-NonCommercial-NoDerivatives 4.0 International License.

Place of publicationUnited Kingdom
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Activation of mTOR signalling in young and old human skeletal muscle in response to combined resistance exercise and whey protein ingestion
Farnfield, Michelle M., Breen, Leigh, Carey, Kate A., Garnham, Andrew and Cameron-Smith, David. (2012). Activation of mTOR signalling in young and old human skeletal muscle in response to combined resistance exercise and whey protein ingestion. Applied Physiology, Nutrition and Metabolism. 37(1), pp. 21 - 30. https://doi.org/10.1139/H11-132
Low muscle glycogen concentration does not suppress the anabolic response to resistance exercise
Camera, Donny, West, D, Burd, N, Phillips, S, Garnham, A, Hawley, John and Coffey, Vernon. (2012). Low muscle glycogen concentration does not suppress the anabolic response to resistance exercise. Journal of Applied Physiology. 113(2), pp. 206 - 214. https://doi.org/10.1152/japplphysiol.00395.2012
Nutrient provision increases signalling and protein synthesis in human skeletal muscle after repeated sprints
Coffey, Vernon, Moore, Daniel, Burd, N, Rerecich, T, Stellingwerff, T, Garnham, A, Phillips, S and Hawley, John. (2011). Nutrient provision increases signalling and protein synthesis in human skeletal muscle after repeated sprints. European Journal of Applied Physiology. 111(7), pp. 1473 - 1483. https://doi.org/10.1007/s00421-010-1768-0
Impact of resistance exercise training on interleukin-6 and JAK/STAT in young men
Trenerry, Marissa K., Della Gatta, Paul A., Larsen, Amy E., Garnham, Andrew P. and Cameron-Smith, David. (2011). Impact of resistance exercise training on interleukin-6 and JAK/STAT in young men. Muscle & Nerve. 43(3), pp. 385 - 392. https://doi.org/10.1002/mus.21875
Impact of resistance exercise training on interleukin-6 and JAK/STAT in young men
Trenerry, Melissa K., Della Gatta, Paul A., Larson, Amy E. and Garnham, Andrew P.. (2011). Impact of resistance exercise training on interleukin-6 and JAK/STAT in young men. Muscle & Nerve. 43(3), pp. 385 - 392. https://doi.org/10.1002/mus.21875
Vitamin D status and musculoskeletal health in adolescent male ballet dancers a pilot study
Ducher, Gaele, Kukuljan, Sonja, Hill, B., Garnham, Andrew P., Nowson, Carol A., Kimlin, M. G. and Cook, Jill. (2011). Vitamin D status and musculoskeletal health in adolescent male ballet dancers a pilot study. Journal of Dance Medicine and Science. 15(3), pp. 99 - 107.
Current markers of the Athlete Blood Passport do not flag microdose EPO doping
Ashenden, Michael, Gough, Clare E., Garnham, Andrew, Gore, Christopher J. and Sharpe, Ken. (2011). Current markers of the Athlete Blood Passport do not flag microdose EPO doping. European Journal of Applied Physiology. 111(9), pp. 2307 - 2314. https://doi.org/10.1007/s00421-011-1867-6
Exercise training increases adipose tissue GLUT4 expression in patients with type 2 diabetes
Hussey, Sophie E., McGee, S. L., Garnham, Andrew, Wentworth, John M., Jeukendrup, A. E. and Hargreaves, M.. (2011). Exercise training increases adipose tissue GLUT4 expression in patients with type 2 diabetes. Diabetes, Obesity and Metabolism. 13(10), pp. 959 - 962. https://doi.org/10.1111/j.1463-1326.2011.01426.x
Acute signalling responses to intense endurance training commenced with low or normal muscle glycogen : Experimental Physiology-Research Paper
Yeo, W, McGee, S, Carey, A, Paton, C, Garnham, A, Hargreaves, M and Hawley, John. (2010). Acute signalling responses to intense endurance training commenced with low or normal muscle glycogen : Experimental Physiology-Research Paper. Experimental Physiology. 95(2), pp. 351 - 358. https://doi.org/10.1113/expphysiol.2009.049353
Cytokine responses to carbohydrate ingestion during recovery from exercise-induced muscle injury
Ross, M, Halson, Shona, Suzuki, K, Garnham, A, Hawley, John, Cameron-Smith, David and Peake, J. (2010). Cytokine responses to carbohydrate ingestion during recovery from exercise-induced muscle injury. Journal of Interferon and Cytokine Research. 30(5), pp. 329 - 337. https://doi.org/10.1089/jir.2009.0079
Effect of consecutive repeated sprint and resistance exercise bouts on acute adaptive responses in human skeletal muscle
Coffey, Vernon Glenn, Jemiolo, Bozena, Edge, Johann, Garnham, Andrew P., Trappe, Scott W. and Hawley, John Alan. (2009). Effect of consecutive repeated sprint and resistance exercise bouts on acute adaptive responses in human skeletal muscle. American Journal of Physiology - Regulatory Integrative and Comparative Physiology. 297(5), pp. 1441 - 1451. https://doi.org/10.1152/ajpregu.00351.2009
Consecutive bouts of diverse contractile activity alter acute responses in human skeletal muscle
Coffey, Vernon Glenn, Pilegaard, Henriette, Garnham, Andrew P., O'Brien, Brendan J. and Hawley, John Alan. (2009). Consecutive bouts of diverse contractile activity alter acute responses in human skeletal muscle. Journal of Applied Physiology. 106(4), pp. 1187 - 1197. https://doi.org/10.1152/japplphysiol.91221.2008
Skeletal muscle adaptation and performance responses to once a day versus twice every second day endurance training regimens
Yeo, Wee Kian, Paton, Carl D., Garnham, Andrew P., Burke, Louise M., Carey, Andrew L. and Hawley, John Alan. (2008). Skeletal muscle adaptation and performance responses to once a day versus twice every second day endurance training regimens. Journal of Applied Physiology. 105(5), pp. 1462 - 1470. https://doi.org/10.1152/japplphysiol.90882.2008
Fat adaptation followed by carbohydrate restoration increases AMPK activity in skeletal muscle from trained humans
Yeo, Wee Kian, Lessard, Sarah J., Chen, Zhi-Ping, Garnham, Andrew P., Burke, Louise, Rivas, Donato A., Kemp, Bruce Ernest and Hawley, John Alan. (2008). Fat adaptation followed by carbohydrate restoration increases AMPK activity in skeletal muscle from trained humans. Journal of Applied Physiology. 105(5), pp. 1519 - 1526. https://doi.org/10.1152/japplphysiol.90540.2008