Ann Pediatr Endocrinol Metab.  2013 Jun;18(2):85-89. 10.6065/apem.2013.18.2.85.

Turner syndrome with primary hyperparathyroidism

• Park J
• Kim YM
• Choi JH
• Lee BH
• Yoon JH
• Jeong WY
• Yoo HW

• KMID: 2047467
• DOI: http://doi.org/10.6065/apem.2013.18.2.85

Abstract

Turner syndrome has multiple comorbidities such as osteoporosis, obesity, diabetes, hypothyroidism, and hypertension. As they are treatable conditions in Turner syndrome, early recognition and proper treatment should be needed. We report on a 23-year-old woman with Turner syndrome who presented with severe osteoporosis and hypercalcemia. Laboratory tests showed elevated levels of serum calcium and parathyroid hormone. Dual-energy X-ray absorptiometry showed severe osteopo-rosis (z score, -3.5). Ultrasound and 99mTc scintigraphy of parathyroid glands showed an adenoma in the right inferior gland. She was diagnosed with primary hyperparathyroidism due to an adenoma of the parathyroid gland. After excision of the adenoma, the patient's serum calcium and parathyroid hormone levels returned to normal. Although only a few cases of Turners syndrome with primary hyperparathyroidism have been reported, hyperparathyroidism should be considered in cases of Turner syndrome with severe osteoporosis and hypercalcemia.

Keyword

Turner syndrome; Hyperparathyroidism; Osteoporosis; Hypercalcemia

MeSH Terms

Absorptiometry, Photon
Adenoma
Calcium
Comorbidity
Female
Humans
Hypercalcemia
Hyperparathyroidism
Hyperparathyroidism, Primary
Hypertension
Hypothyroidism
Obesity
Osteoporosis
Parathyroid Glands
Parathyroid Hormone
Turner Syndrome
Calcium
Parathyroid Hormone

Figure

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  Fig. 1 Parathyroid scintigraphy of the patient demonstrated adenoma in the right inferior parathyroid gland (white arrow).

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  Fig. 2 Microscopic findings of the excised parathyroid adenoma of patient. (A) The tumor is well circumscribed and lack of stromal fat, which is abundant in the normal gland at the periphery. The tumor cells are arranged in solid sheets or follicular structure (H&E, ×40). (B) The tumor is predominantly composed of chief cells intermingled with oxyphilic cells (H&E, ×200).

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  Fig. 3 Comparison of laboratory findings before and after operation. Pre-OP, pre-operation; POD, post-operation day.

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