Medullary Nephrocalcinosis Secondary to Parathyroid Adenoma

M Stephen Ledbetter, MD
Donald DiSalvo, MD

July 24, 1996

Presentation

A 27-year-old woman at 14 weeks' gestation presented with nausea and vomiting. Blood work revealed hypercalcemia.

Imaging Findings

Transabdominal sonogram

Sonogram of the neck

Transabdominal ultrasound demonstrates pyramid-shaped hyperechoic structures (arrows) within the kidneys bilaterally with posterior acoustic shadowing. Subsequent ultrasound of the neck demonstrates a large hypoechoic mass (arrows) posterior to the left lobe of the thyroid.

Differential Diagnosis

Two possibilities include medullary sponge kidney, a hereditary condition in which the underlying pathology is ectasia of the collecting tubules, and medullary nephrocalcinosis due to hypercalcemia which may result from:

hyperparathyroidism (primary or ectopic)
bony metastases
hypervitaminosis D
sarcoid
renal tubular acidosis

Diagnosis

Medullary nephrocalcinosis secondary to parathyroid adenoma

Discussion

Hyperparathyroidism is caused by excessive function of the parathyroid gland. The condition may be primary, as in association with a parathyroid adenoma, hyperplasia, or carcinoma, or may be secondary, as in patients with renal failure on long-term dialysis. Hyperparathyroidism occurs in 1 of 800 adults and is more common in women, especially those who are postmenopausal. The production of excessive parathyroid hormone leads to changes in bone cells, renal tubules, and the gastrointestinal mucosa. This results in the resorption of calcium from the skeletal system (osteoporosis) and the absorption of calcium by the kidneys and gastrointestinal tract, which may lead to such complications as renal stones, calcium deposits in the renal tubules, pancreatitis, and osteoporosis.

References

Krebs CA, Giyanani, VL, Eisenberg RL. Ultrasound atlas of disease processes. Norwalk, CT: Appleton & Lange, 1993: 378.

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