Endocrine Abstracts

Introduction: Primary hyperparathyroidism affects 1% of the world’s population, with majority of cases due to benign parathyroid adenomas. Parathyroid cancer is a rare cause.

Case report: This case report describes a 53-year-old lady presenting with nonspecific bone pains, whose initial workup revealed mild hypercalcemia and MRI lumbosacral spine suggestive of multiple myeloma. Subsequent work up, including two bone marrow examinations and serum protein electrophoresis were negative for myeloma. Sestamibi scan was also negative. A phenomenally elevated PTH level (2105 pg/ml, normal range 16–87) and rising serum calcium ordered years later prompted a repeat sestamibi scan and ultrasonography of neck. DEXA scan was consistent with severe osteoporosis. Based on the PTH levels, and radiologic findings, a diagnosis of primary hyperparathyroidism, with a high suspicion of parathyroid cancer, was made. Renal function tests and neurologic status remained essentially normal. Following this, the patient underwent surgical tumor resection with subsequent histopathological confirmation of the diagnosis.

Conclusions: In the setting of hypercalcemia, parathyroid hormone assessment is essential, leading to a comprehensive work up of its cause. Carcinoma needs to be considered in the differentials of primary hyperparathyroidism, particularly in the setting of high parathyroid levels, and mandates urgent surgical removal.