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[Coronary heart disease as the initial manifestation of primary hyperparathyroidism]
I Schafhalter-Zoppoth1, B Eber, S Lax
1Medizinische Universitätsklinik, Graz.
Insights
This case highlights a 57-year-old female with coronary artery disease who was incidentally diagnosed with primary hyperparathyroidism due to hypercalcemia. The study details the simultaneous surgical treatment of both conditions.
Area of Science:
- Endocrinology
- Cardiology
- Surgical Pathology
Background:
- Coronary artery disease (CAD) necessitates surgical intervention, often involving aortocoronary bypass grafting.
- Primary hyperparathyroidism is a condition characterized by excessive parathyroid hormone production, leading to hypercalcemia.
- Co-occurrence of CAD and primary hyperparathyroidism presents complex diagnostic and therapeutic challenges.
Observation:
- A 57-year-old female presented with unstable angina pectoris, diagnosed with diffuse 3-vessel disease requiring bypass surgery.
- Pre-operative evaluation revealed hypercalcemia and elevated parathormone levels, with ultrasonography showing enlarged parathyroid glands.
- The patient had a history of stomach/duodenal ulcers and nephrolithiasis, suggesting long-standing metabolic disturbances.
Findings:
- Simultaneous surgical management included four aortocoronary bypass grafts and removal of four hyperplastic parathyroid glands.
- Histological examination confirmed water clear cell hyperplasia of the parathyroid glands.
- Primary hyperparathyroidism was diagnosed post-coronary arteriography, despite years of related symptoms.
Implications:
- This case underscores the importance of investigating hypercalcemia in patients with significant coronary artery disease.
- Simultaneous surgical treatment can be effective for managing concurrent cardiovascular and endocrine conditions.
- Early diagnosis and management of primary hyperparathyroidism may prevent long-term complications, including cardiovascular events.
Abstract:
Due to unstable angina pectoris coronary arteriography was performed in a 57 year-old female, showing diffuse 3-vessel disease; aortocoronary bypass surgery was recommended. During routine pre-operative examination hypercalcemia, as well as an elevated value of parathormone were observed. Ultrasonography of the parathyroid glands showed two enlarged cranial glands. In a simultaneous surgical procedure 4 bypass grafts were performed and 4 hyperplastic parathyroid glands were removed, one of which was re-operated as an autotransplantation in the left musculus adductor magnus. Histological examination showed water clear cell hyperplasia of the parathyroid glands. Though the patient had suffered from stomach and duodenal ulcers and nephrolithiasis over several years, primary hyperparathyroidism was diagnosed only after angiographically proven coronary artery disease.