An Autopsy Case of Primary Hyperparathyroidism (Parathyroid Cancer) Associated with Hyperreninemia

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  • NISHINO Tomokatsu
    Department of Internal Medicine, Hokuriku Hospital
  • ONCHI Kazuaki
    Department of Internal Medicine, Hokuriku Hospital
  • OOE Kunihiro
    Department of Internal Medicine, Hokuriku Hospital
  • TAKEGOSHI Tadayoshi
    Department of Internal Medicine, Hokuriku Hospital
  • HIRAMARU Yoshitake
    Department of Internal Medicine, Hokuriku Hospital
  • IMURA Masaru
    Department of Internal Medicine, Hokuriku Hospital
  • TAKEUCHI Nobuo
    Department of Internal Medicine, Hokuriku Hospital
  • TOFUKU Yohei
    The Second Department of Internal Medicine, School of Medicine Kanazawa University
  • UCHIDA Kenzo
    The Second Department of Internal Medicine, School of Medicine Kanazawa University
  • USUKURA Noriomi
    The Second Department of Internal Medicine, School of Medicine Kanazawa University
  • SATO Takashi
    The Second Department of Internal Medicine, School of Medicine Kanazawa University
  • MATSUI Shinobu
    The Second Department of Internal Medicine, School of Medicine Kanazawa University
  • MORIMOTO Shinpei
    The Second Department of Internal Medicine, School of Medicine Kanazawa University
  • TAKEDA Ryoyu
    The Second Department of Internal Medicine, School of Medicine Kanazawa University
  • OHTA Goroku
    The Second Department of Pathology, School of Medicine, Kanazawa University
  • YOSHIZAWA Hiroshi
    The Second Department of Pathology, School of Medicine, Kanazawa University

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Other Title
  • autopsy case of primary hyperparathyroi

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31-year-old female. During her first pregnancy, she was found to have hypertension, proteinuria and anemia. These symptoms subsided after intrauterine death of fetus at the 3rd trimester, but redeveloped in her 2nd pregnancy. Thirst and polydipsia developed during pregnancy and persisted following the delivery. She first visited our Clinic because of nausea, vomiting, abdominal pain and anemia. These symptoms improved with ambulant therapy. She complained of right ulnar pain due to a right ulnar cyst. Amass in the right neck was found, and laboratory tests revealed marked hypercalcemia, hypophosphatemia, increased alkaline phosphatase and renal dysfunction. Cystic fibrous ostitis, nephrocalcinosis and gastric ulcer were confirmed. Marked elevation of plasma renin activity associated with hyperaldosteronism and proximal renal tubular acidosis were demonstrated. After removal of parathyroid tumor, hypercalcemia and hyperreninemia definitely improved. She died of hypercalcemic crisis due to recidivation of hyperparathyroidism. Postmorten examination : Recidivation of the right parathyroid cancer with metastases to adjacent fatty tissue and right lobe of the thyroid and periparathyroid lymph nodes. Extensive fibrous ostitis, bilateral nephrocalcinosis, calcification of alveolar walls and heart muscle, pyelonephritis, gastric ulcer, cystitis and mild pulmonary edema.<br> The authors assumed that hyperreninemia associated with hyperaldosteronism in this case was secondary to proximal renal tubular acidosis and hypercalcemia.

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