Clinical History -- Hypercalcemia

Past Medical History:
In January of 1972 the patient presented with flank pain which was diagnosed as renal colic due to a renal calculus. Persistent hypercalcemia was noted at that time, resulting in a clinical diagnosis of primary hyperparathyroidism.

Following this, she underwent a neck exploration with four parathyroid glands being removed. In May 1974 she experienced recurrent hypercalcemia and had accessory parathyroid glands removed. In late 1974 a subtotal thyroidectomy was done due to persistent hypercalcemia. The thyroid tissue revealed within itself accessory parathyroid tissue.

Recent Medical History:
In 1993 an MRI revealed a 2.0 cm pituitary adenoma. At that time there was no evidence of hormone secretion. However, further evaluation revealed elevated prolactin levels.

In 1994 she was again noted to have recurrent hypercalcemia. Additional laboratory data showed that she had episodic elevations of gastrin and a rising pancreatic polypeptide level. She has a long history of hypertension and had on CT scan bilateral adrenal enlargement with normal 24-hour urinary free cortisol and no suppression of the cortisol level following Decadron administration.

History of Present Illness:
Recently, a CT scan revealed an anterior mediastinal mass for which the patient had an ultrasound guided fine needle aspirate. She continued to have hypercalcemia, and is now admitted for resection of the anterior mediastinal mass. Intraoperatively, an ectopic parathyroid gland (approximately 0.5 grams) was found in the left thoracic outlet.

Family History:
Family history reveals a mother who had severe gastric ulcers, underwent a total gastrectomy, was confirmed to have pancreatitis as well and is presumed to have MEN Type I. Her brother has been diagnosed as having MEN Type I with parathyroid adenomas and a gastrinoma. Her father had colon cancer diagnosed at age 69.

Laboratory Data