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A unique ca(u)se of quadriparesis.
Sadishkumar Kamalanathan1, Karthik Balachandran, Dhanapathi Halanaik
1Endocrinology Department, Jawaharlal Institute of Post Graduate Medical Education & Research, Puducherry, India. sadishkk@gmail.com
BMJ Case Reports
|June 26, 2012
Summary
Primary hyperparathyroidism, a rare cause of weakness, was linked to severe vitamin D deficiency. Surgical removal of an ectopic parathyroid adenoma cured the patient, highlighting the importance of considering PHPT in unexplained neuromuscular symptoms.
Area of Science:
- Endocrinology
- Neurology
- Surgical Pathology
Background:
- Primary hyperparathyroidism (PHPT) is an uncommon endocrine disorder.
- It can present with non-specific neuromuscular weakness, often leading to delayed diagnosis.
- Severe vitamin D deficiency can complicate PHPT presentation.
Observation:
- A patient presented with severe quadriparesis attributed to PHPT and profound 25-hydroxyvitamin D (25(OH)D) deficiency.
- Initial biochemical findings included normocalcaemic hyperparathyroidism with hypophosphatemia.
- Correction of vitamin D deficiency unmasked significant hypercalcaemia.
Findings:
- Radiology and scintigraphy localized a parathyroid adenoma.
- An ectopic supernumerary parathyroid adenoma was discovered and surgically removed from the right tracheoesophageal groove.
- Histopathological confirmation of parathyroid adenoma was obtained.
Implications:
- This case underscores the importance of considering PHPT in patients with unexplained neuromuscular weakness, especially when accompanied by vitamin D deficiency.
- Surgical intervention for parathyroid adenoma can lead to complete cure.
- Ectopic parathyroid tissue should be considered in surgical exploration for PHPT.
