Primary hyperpathyroidism from parathyroid carcinoma presenting with multiple skeletal fractures and brown cell tumors

Abstract

We report the case of a 19-year old Filipino woman who presented with hard masses on the left upper arm and leg with multiple fractures on all extremities. Her serum calcium and intact parathyroid hormone (iPTH) levels were elevated, while serum phosphorus was low. Ultrasonography of the neck revealed a left inferior parathyroid mass. Ultrasoundguided fine needle aspiration of the mass revealed findings consistent with parathyroid carcinoma. After hydration and administration of diuretic and bisphosphonate to control the severe hypercalcemia, she subsequently underwent 3½ gland parathyroidectomy with en-bloc left thyroid lobectomy. There was immediate normalization of biochemical indices after surgery. Three months later, the fractures on all extremities were fully resolved.