DOI: 10.36347/sjmcr.2016.v04i09.003

Pages: 641-643

Primary hyperparathyroidism the most important cause for hypercalcemia, is due to an inappropriate excess secretion of parathyroid hormone .A 13 year old boy attended OPD, at Rajiv Gandhi government general hospital , Chennai, with the complaints of recurrent abdominal pain and vomiting. Provisionally he was diagnosed to have acute pancreatitis as evident by ultrasound abdomen and serum Amylase. Further laboratory investigations showed elevated serum Calcium (16.4mg/dl) and Parathormone levels (239.2pg/ml). MRI Neck showed left inferior parathyroid adenoma. A final diagnosis of Parathyroid adenoma resulting in Primary hyperparathyroidism was made. The patient was taken up for surgery - Inferior parathyroidectomy along with cervical thymectomy was done. On the third post operative day the patient developed symptoms of acute pancreatitis. Serum Amylase, S. Lipase, S.PTH and calcium remained elevated. Tc-99m Sestamibiscan done showed a lesion behind left sternoclavicular joint. The patient was taken for up for neck re-exploration surgery 10 days later and suspicious tissue as evident in the scan was removed. This time intra-operative PTH estimation was ordered. Sample for intra-operative PTH assay was collected 15 minutes after the removal of the mass. The intra-operative Parathyroid value was 14.2 pg/ml. A fall >50 % of the pre-op value is suggestive of adequate removal of the tumor. Post-operatively the PTH and calcium values were 13.6pg/ml and 10mg/dl respectively. Post-operative period was uneventful. This insists the importance of doing intra-operative PTH assay while removing the parathyroid adenoma especially when facility for intra-operative frozen section is unavailable.