Unexpectedly, removal of the parathyroid gland did not decrease serum calcium therefore, we speculated that high calcium might not be caused by hyperparathyroidism alone. The pathological result of the removed tissue suggested nodular goiter. Finally, although the nature of the parathyroid lesions was not yet clear, to reduce serum calcium, exploratory parathyroidectomy was performed on Ap(Figure 2). To determine the cause of the elevated calcium, a multidisciplinary expert was consulted, and further workup was proposed. Refractory hypercalcemia ultimately decreased to normal level after cytoreductive surgery on May 11. ![]() The serum amylase gradually recovered to normal level whereas the intact parathyroid hormone concentration decreased after exploratory parathyroidectomy, which was performed 25 d after admission. MRI of the pelvis (Figure 1K and L) suggested malignant lesions of the uterus and multiple uterine fibroids.įigure 2 The serum concentration of amylase, calcium, and intact parathyroid hormone during the disease course of this patient. Contrast enhanced CT of the neck (Figure 1I and J) showed nodules located at the junction of the left lobe of the thyroid and parathyroid gland. A repeat non-contrast enhanced CT scan of the abdomen (Figure 1E and F) and head MRI (Figure 1G and H) showed a reduction in pancreatic exudation and abnormal head signals after effective treatment. ![]() Head magnetic resonance imaging (MRI) was performed, and abnormal signals were found in the bilateral fronto-parietal-temporal-occipital cortex-medullary junction area and bilateral paraventricular area, which were likely due to metabolic encephalopathy related to pancreatitis (Figure 1C and D). Ultrasound examination of the neck revealed an inferior thyroid nodule and mild hyperplasia of the parathyroid gland. Non-contrast enhanced computed tomography (CT) of the abdomen showed exudation around the pancreas (Figure 1A and B).
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