Kalkvakaóhóf vegna kalkkirtilsæxlis í brjóstholi – sjúkratilfelli með umfjöllun

Abstract

A 72 year old gentleman presented to the emergency department with symptoms of diffuse joint and muscular pain, fatigue and diminished memory. Serum calcium and parathyroid hormone levels were raised, consistent with primary hyperparathyroidism. No abnormality was found on an ultrasound scan of the neck. However, a sestamibi scan suggested a possible adenoma in the anterior mediastinum, which on computed tomography (CT) scan was 1.5 cm in size. A partial upper sternotomy was performed in order to excise the adenoma and his symptoms disappeared within several weeks. This case highlights the variable and commonly nonspecific symptoms of primary hyperparathyroidism and the less well known fact that parathyroid adenoma may occasionally be found intrathoracically.

72 ára karlmaður leitaði á bráðamóttöku vegna dreifðra lið- og vöðvaverkja, þreytu og minnisleysis. Bæði kalk í sermi (S-Ca2+) og kalkvaki (S-PTH, serum parathyroid hormone) reyndust hækkuð en stækkaðir kalkkirtlar fundust ekki við ómskoðun af hálsi. Á kalkirtlaskanni sást hins vegar aukin upptaka í fremra miðmæti sem á tölvusneiðmynd reyndist vera 1,5 cm stór fyrirferð. Fyrirferðin var fjarlægð í gegnum bringubeinsskurð og reyndist góðkynja kalkkirtilsæxli (adenoma). Einkenni hurfu á nokkrum vikum. Tilfellið sýnir hversu fjölskrúðug einkenni geta fylgt frumkomnu kalkvakaóhófi og að orsök þess getur verið kalkkirtilsæxli staðsett í brjóstholi.