Fatal Arrhythmia with Brugada-Type Electrocardiograms in a Patient with Primary Hyperparathyroidism: A Rare Case Report

Wen Liu1, Juan Du1, Nan Zhao1, Xiaohong Jiang1, Fan Hu2 and Shan Huang1*

1Department of Endocrinology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China 2Department of Endocrinology, Shanghai Jiao Tong University School of Medicine, China

^*Correspondance to: Shan Huang 

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Abstract:

Background: Primary Hyperparathyroidism (PHPT) is a calcium-related metabolic disorder characterized by hypercalcemia and excessive secretion of Parathyroid Hormone (PTH). PHPT can manifest with nephrolithiasis and osteoporosis as well as with vertebral fractures. Recent studies have investigated cardiovascular findings in PHPT, including asymptomatic coronary artery disease, valve calcification and left ventricular hypertrophy, nephrocalcinosis is a possible complication of hyperparathyroidism. Fatal arrhythmias, such as Brugada-type electrocardiograms, have been described in only a few case reports of PHPT. Case Summary: Here, we present the case of a 53-year-old male with episodic palpitations, syncope and paroxysmal ventricular fibrillation who had a high risk of sudden death. Electrocardiogram (ECG) findings during hospitalization were characterized by a coved ST-segment elevation in the right precordial leads, similar to Brugada syndrome. A single-chamber Implantable Cardioverter- Defibrillator (ICD) was implanted, and ventricular fibrillation was repeatedly recorded. Other systemic symptoms of PHPT included kidney stones, persistently high calcium and low phosphorus levels, hypokalemia, and severe osteoporosis. The diagnosis of PHPT was made according to elevated levels of calcium (2.9 mmol/L, normal range: 2.11 mmol/L to 2.52 mmol/L) and PTH (40.85 pmol/L, normal range: 1.6 pmol/L to 6.9 pmol/L). A parathyroid adenoma was detected by parathyroid ultrasound and CT scan; it was located in the left lesion and was successfully exhibited by increased technetium-99m Methoxyisobutylisonitrile (99mTc-MIBI) uptake. Postoperatively, PTH levels normalized, as the serum calcium level remained in the normal range after parathyroidectomy. No arrhythmia event occurred during the 1-year follow-up. Conclusion: We described a rare case of hyperparathyroidism presenting as hypercalcemia and fatal arrhythmia. The evidence that the arrhythmia was resolved following the resolution of PHPT after surgery supports our results.

Keywords:

Brugada-type electrocardiograms; Primary hyperparathyroidism; Hypercalcemia

Cite the Article:

Liu W, Du J, Zhao N, Jiang X, Hu F, Huang S. Fatal Arrhythmia with Brugada-Type Electrocardiograms in a Patient with Primary Hyperparathyroidism: A Rare Case Report. Ann Clin Case Rep. 2022; 7: 2225..