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CASE REPORT
Hypercalcaemic encephalopathy due to metastatic parathyroid carcinoma
  1. Dhalapathy Sadacharan1,2,
  2. Shriraam Mahadevan1,3,
  3. Jabamalai Ferdinant2,
  4. Kaharin Rakeshchandru2
  1. 1 Department of Endocrinology, Endocrine and Speciality Clinic, Chennai, Tamilnadu, India
  2. 2 Department of Endocrine Surgery, Madras Medical College, Chennai, Tamilnadu, India
  3. 3 Department of Endocrinology, Sri Ramachandra Medical College, Chennai, Tamil Nadu, India
  1. Correspondence to Dr Shriraam Mahadevan, mshriraam{at}gmail.com

Summary

A 49-year-old man presented in the emergency department with altered sensorium and renal failure and was placed on a ventilator. Evaluation with MRI of the brain showed enhancing lesion in the occipital lobe. Biochemical tests revealed elevated calcium and parathyroid hormone (PTH) levels. Further evaluation revealed multiple lesions at both lobes of the lungs and nodular lesion in the right inferior pole of the thyroid. Diagnosis of metastatic parathyroid carcinoma was suspected. Patient was stabilised with bisphosphonates and haemodialysis and planned for surgery. Intraoperatively a hard lesion was found in the right inferior parathyroid infiltrating the surrounding structures. En bloc resection was done. General condition of the patient improved and he was weaned from the ventilator. Histopathology confirmed the diagnosis of parathyroid carcinoma. Postoperatively, there was persistent elevation of PTH in spite of a fall in calcium levels indicating functioning brain and pulmonary metastases. Due to extensive metastases, the patient was given palliative cinacalcet and was kept under follow-up.

  • Calcium and bone
  • Metabolic disorders
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Footnotes

  • Contributors DS and SM have contributed in the management of the case and overseeing the manuscript preparation. JF and KR were involved in the preparation of the manuscript.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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