Thrombosis of cerebral vessels as a primary manifestation of parathyroid adenoma

Czech version

Authors: K. Mamiňák ^1,2; Ľ. Michnová ³; Tomáš Tyll ⁴; Jaromír Astl ^1,2
Authors‘ workplace: Klinika otorinolaryngologie a maxilofaciální chirurgie 3. LF UK a ÚVN Praha ¹; 3. lékařská fakulta, Univerzita Karlova, Praha ²; Oddělení patologie, ÚVN Praha ³; Klinika anesteziologie, resuscitace a intenzivní medicíny 1. LF UK a ÚVN – VFN Praha ⁴
Published in: Otorinolaryngol Foniatr, 73, 2024, No. 3, pp. 197-202.
Category: Case Reports
doi: https://doi.org/10.48095/ccorl2024197

Overview

Primary hyperparathyroidism (HPPT) is a generalized disorder of calcium-phosphate metabolism resulting from long-term secretion of parathyroid hormone (PTH). The most common cause of PTH overproduction is an adenoma of one or more parathyroid glands. Cerebral venous sinus thrombosis accounts for about 1–2% of cerebral events and its consequence can be focal ischemia with intracerebral hemorrhage. In this article, we describe a unique case report of a patient who was urgently admitted for the progression of a sudden speech disorder and progressive impairment of consciousness on the basis of thrombosis in the cerebral sinuses and intracerebral hemorrhage. Secondary findings at the initial diagnostic process were hypophosphatemia and hypercalcemia with parathyroid hormone elevation.

Keywords:

hyperparathyroidism – hypercalcemia – cerebral venous sinus thrombosis

Sources

1. Bilezikian JP, Bandeira L, Khan A et al. Hyperparathyroidism. Lancet 2018; 391 (10116): 168–178. Doi: 10.1016/S0140-6736 (17) 31430-7.

2. Walker MD, Silverberg SJ. Primary hyperparathyroidism. Nat Rev Endocrinol 2018; 14 (2): 115–125. Doi: 10.1038/nrendo.2017.104.

3. Oberger Marques JV, Moreira CA. Primary hyperparathyroidism. Best Pract Res Clin Rheumatol 2020; 34 (3): 101514. Doi: 10.1016/ j.berh.2020.101514.

4. Procopio M, Barale M, Giaccherino RR et al. Clinical Manifestations of Primary Hyperparathyroidism. In: Gasparri G et al (eds). Primary, Secondary and Tertiary Hyperparathyroidism. Milano: Springer Milan 2016 : 57–72. Updates in Surgery. Doi: 10.1007/978-88-470-57 58-66.

5. Eastell R, Brandi ML, Costa AG et al. Diagnosis of asymptomatic primary hyperparathyroidism: proceedings of the Fourth International Workshop. J Clin Endocrinol Metab 2014; 99 (10): 3570-3579. doi: 10.1210/jc.2014-1414.

6. Pepe J, Cipriani C, Sonato C et al. Cardiovascular manifestations of primary hyperparathyroidism: a narrative review. Eur J Endocrinol 2017; 177 (6): R297–R308. Doi: 10.1530/EJE-17 -⁠ 0485.

7. Fisher SB, Perrier ND. Primary hyperparathyroidism and hypertension. Gland Surg 2020; 9 (1): 142–149. Doi: 10.21037/gs.2019.10.21.

8. Hilgard P. Experimental hypercalcaemia and whole blood clotting. J Clin Pathol 1973; 26 (8): 616–619. Doi: 10.1136/jcp.26.8.616.

9. Ferro JM, Canhao P. Cerebral venous sinus thrombosis: update on diagnosis and management. Curr Cardiol Rep 2014; 16 (9): 523. Doi: 10.1007/s11886-014-0523-2.

10. Capecchi M, Abbattista M, Martinelli I. Cerebral venous sinus thrombosis. J Thromb Haemost 2018; 16 (10): 1918–1931. Doi: 10.1111/jth.14210.

11. Idiculla PS, Gurala D, Palanisamy M et al. Cerebral Venous Thrombosis: A Comprehensive Review. Eur Neurol 2020; 83 (4): 369–379. Doi: 10.1159/000509802.

12. Bostrom H, Alveryd A. Stroke in hyperparathyroidism. Acta Med Scand 1972; 192 (4): 299–308. Doi: 10.1111/j.0954-6820.1972.tb04819.x.

13. Walker GL, Williamson PM, Ravich RB et al. Hypercalcaemia associated with cerebral vasospasm causing infarction. J Neurol Neurosurg Psychiatry 1980; 43 (5): 464–467. Doi: 10.1136/jnnp.43.5.464.

14. Erem C, Kocak M, Hacihasanoglu A et al. Blood coagulation, fibrinolysis and lipid profile in patients with primary hyperparathyroidism: increased plasma factor VII and X activities and D-Dimer levels. Exp Clin Endocrinol Diabetes 2008; 116 (10): 619–624. Doi: 10.1055/s-2008-1065365.

15. Erem C, Kocak M, Nuhoglu I et al. Increased plasminogen activator inhibitor-1, decreased tissue factor pathway inhibitor, and unchanged thrombin-activatable fibrinolysis inhibitor levels in patients with primary hyperparathyroidism. Eur J Endocrinol 2009; 160 (5): 863–868. Doi: 10.1530/EJE-09-0069.

16. Koufakis T, Antonopoulou V, Grammatiki M et al. The Relationship between Primary Hyperparathyroidism and Thrombotic Events: Report of Three Cases and a Review of Potential Mechanisms. Int J Hematol Oncol Stem Cell Res 2018; 12 (3): 175–180.

17. Riyaz S, Tymms J. Hypercalcemia: A rare cause of cerebral infarction. Central European Journal of Medicine 2008; 3 (4): 514–516. Doi: 10.2478/s11536-008-0046-6.

18. Chan NC, Chu HM. Management of hyperparathyroid-induced hypercalcaemic crisis with intracardiac thrombi. Anaesth Rep 2019; 7 (2): 83–87. doi: 10.1002/anr3.12026.

19. Luigi P, Chiara FM, Laura Z et al. Arterial Hypertension, Metabolic Syndrome and Subclinical Cardiovascular Organ Damage in Patients with Asymptomatic Primary Hyperparathyroidism before and after Parathyroidectomy: Preliminary Results. Int J Endocrinol 2012; 2012 : 408295. doi: 10.1155/2012/408295

ORCID autorů

K. Mamiňák 0000-0002-3935-5891,

Ľ. Michnová 0000-0002-7641-2808,

T. Tyll 0000-0003-4000-3495,

J. Astl 0000-0002-8022-0200.

Přijato k recenzi: 28. 8. 2023

Přijato k tisku: 2. 10. 2023

MUDr. Kristýna Mamiňák

Klinika otorinolaryngologie a maxilofaciální chirurgie

3. LF UK a ÚVN Praha

U Vojenské nemocnice 1200

169 02 Praha 6