Aim: To present a case of severe primary hyperparathyroidism (PHPT) manifested predominantly with polyuria.
Case: A 53 years old caucasian female presented to the emergency room with polyuria (5-6 l), and increasing during last 4 weeks dehydration, weight loss (10 kg), weakness, confusion. Diabetes mellitus and insipidus had been excluded. After hypercalcemia (3.63.9 mmol\l), Ca++ to 2.0 mmol\l and PTH of 616 pg\ml (1162) were revealed acute PHPT was diagnosed. There were no bone changes and nephrolythiasis. Creatinine 65 mcmol\l (4480), urine specific gravidity 10031015. D-dimers level >20 mcg\ml (00.5) witnessed about disseminated intravascular coagulation (DIC). Rehydration, calcitonin, magnesium, potassium, glucocorticoids, heparin were administered. USG: hyperplasia of inferior parathyroid glands (PG), adenoma not excluded. Transcutaneous biopsy: PG hyperplasia. Disease severity dictated necessity of surgical PG exploration without delay. Hyperplasia of all PGs was revealed, especially right inferior (2.5×2.0×1.4 cm). Three PG an half of left superior PG were surgically removed. Intraoperative PTH measurements: transient 3-times increase of PTG level during parathyroidectomy (result of surgical trauma) with following decrease to the end of operation to 63 pg\ml, and to 16.5 pg\ml 3 h after operation.
Histopathology: Hyperplasia of PG chief cells, most pronounced in right inferior PG. Hypocalcemia (1.5 mmol\l) without Chwostek sign developed only to 5th day after parathyroidectomy and necessary treatment followed. PTH level preserved on 16.5 pg\ml.
Conclusion: Acute PHPT due to PG hyperplasia manifesting with polyuria is relatively rare and may be successfully urgently treated (being accompanied by DIC) without complicated diagnostic procedures.