Spontaneous remission of primary hyperparathyroidism: a case report and meta-analysis of the literature

Abstract

Background: In a minority of patients, primary hyperparathyroidism spontaneously remits either by autoinfarction or by hemorrhage into or around the adenoma. We describe a case of autoparathyroidectomy occurring in a 63-year-old man 9 years after three parathyroid glands were removed during a total thyroidectomy. This case is compared with 50 previously reported cases of autoparathyriodectomy, and a meta-analysis is performed.

Methods: Case report, literature review, and meta-analysis were done using statistical software (SigmaStat 2.0, SPSS, Chicago).

Results: Fifty cases of autoparathyroidectomy were summarized according to the three etiologies. The greatest biochemical aberration was found in the acute intracapsular hemorrhage group, with [Ca(++)] falling from a mean 15.1 mg/dL to 8.9 mg/dL. The average drop in parathyroid hormone was 69% across all groups, comparing favorably to surgical resection.

Conclusions: Autoparathyroidectomy is a rare but described outcome of unoperated primary hyperparathyroidism that may delay or supplant operative management.