CASE HISTORY – June 2010

Case history: rare cause of hypercalcaemia


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A 48-year-old man was hospitalised with general weakness, progressing muscle fatigue over the past 5 years, pain in the joints and muscles, muscle waisting, loss of appetite, nausea, vomiting and weight loss. The patient had a history of hypertension for 12 years. A year before, he had been diagnosed with coxarthrosis. Ultrasound examination indicated chronic renal damage. Laboratory tests revealed anaemia, elevated serum alkal ine phosphatase level and hypercalcaemia. Tests for autoantibodies and tumour markers appeared negative. Three days af ter hospitalisation the patient had sudden death, and postmortem  examination revealed yellow-white, hard, ovoid tumour fixed to the left thyroid lobe and measuring 3 X 4 cm in diameter. Histologically, all criteria for the diagnosis of malignancy in the parathyroid neoplasm were fulfilled: there were vascular and neural invasion, thyroid invasion and distant retroperitoneal metastases. The parathyroid nature of the neoplasm was confirmed by positive immunostaining for parathyroid hormone. As a result of hypercalcaemia, there were abundant renal calcificates. Sudden death occured most probably due to hypercalcemia-related cardiac dysrhytmia.