[A Case of Primary Hyperparathyroidism Complicated with Hypercalcemic Crisis during Treatment with Cinacalcet and...

A 77-year-old man was referred to our department for surgical treatment of a right ureteral stone identified on computed tomography (CT) during intensive examination for spondylolisthesis of L4-L5. At the initial visit, performance status was 4, and renal dysfunction was identified (Cr 1.3 mg/dl). Corrected calcium level was 11.8 mg/dl, and intact parathyroid hormone level was 555 pg/ml. A CT scan showed a well-defined mass measuring 22×16×20 mm on the right side of the esophagus, along with 99mTc-MIBI uptake in the lesion. Based on these findings, we diagnosed the patient with primary hyperparathyroidism. Considering his general condition, we determined that parathyroidectomy was difficult, and we started treatment using cinacalcet. A temporary therapeutic effect was observed, but the turning point was occurrence of hypercalcemic crisis with aspiration pneumonia. After recovery of his general condition and improvement of blood data by multidisciplinary therapy, we performed parathyroidectomy. Histopathological examination showed that the tumor was a parathyroid adenoma. He is free of reccurence at one year postoperatively. In addition, surgery for spondylolisthesis was performed, and he started to walk independently.