Hypercalcemia is a recognised feature of parathyroid and neoplastic disorders and similarly erythrocytosis is recognised in some benign and malignant neoplasm.
A 71-year-old man presented to the admissions unit with an episode of collapse. No significant neurological or cardiovascular cause was identified. The results of his routine investigation revealed haemoglobin of 19.7g/dl and a haematocrit of 62%. Further investigations were consistent with primary polycythaemia. Biochemical tests also revealed primary hyperparathyroidism with a corrected serum calcium of 3.24mmol/l (2.1-2.5mmol/l) and a PTH of 206micromol/ml (12-72). Polycythaemia responded to repeated venesections and the patient is awaiting parathyroid surgery.
An increased incidence of synchronous and metachronous malignant neoplasm in other organs has been described in association with primary hyperparathyroidism. In particular, the risk of polycythaemia rubra Vera and bladder cancer was significantly higher compared to that in the general population. It has been shown that there is a possible physio-pathogenic role for PTH in stimulation of erythropoesis. Clinicians should be aware of this when presented with patients with hyperparathyroidism.
08 - 11 Apr 2002
British Endocrine Societies