Unusual recurrence of hypercalcemia due to concurrent parathyroid adenoma and parathyroid sarcoidosis with lymph node...

To describe a patient presenting with the rare findings of synchronous parathyroid adenoma and parathyroid sarcoidosis.

We describe the clinical history, physical examination findings, laboratory values, imaging findings, and pathologic data of a man who developed recurrent severe hypercalcemia after successful parathyroidectomy.

A 67-year-old man had the following initial blood test results: calcium, 11.1 mg/dL (reference range, 8.5-10.6 mg/dL); albumin 4.0 g/dL (reference range, 3.2- 5.2 g/dL); intact parathyroid hormone, 166 pg/mL (reference range, 10-69 pg/mL); creatinine, 1.9 mg/dL; 25-hydroxyvitamin D, 15 ng/mL (reference range, 30-80 ng/mL); and 1,25-dihydroxyvitamin D, 44 pg/mL (reference range, 16-72 pg/mL). Chest x-ray was normal, and delayed images from a technetium Tc 99m sestamibi scan showed increased activity in the right lower pole of the thyroid. Two months after successful parathyroidectomy, the patient was admitted to the hospital with a serum calcium concentration of 17 mg/dL. Pathologic examination of the resected gland confirmed the diagnosis of parathyroid adenoma, and subsequent review disclosed the presence of noncaseating granulomas within the adenoma.

Sarcoidosis with parathyroid involvement causing severe hypercalcemia is unique to this case. Recurrent hypercalcemia after successful resection of a parathyroid adenoma may require consideration of potential causes other than the initial diagnosis.