Endocrine Abstracts

It is to delineate two categories of hypercalcemia: hypercalcemia associated with dysfunction of the parathyroid gland and hypercalcemia that occurs despite appropriate parathyroid suppression.

There is casuistic model of 73 years old woman with several years personal history of hypercalcemia and clinical polyarthritis. After standard examinations there was diagnosed primary hyperparathyroidism. USG screening expected adenoma of parathyroid gland right down, but increased accumulation of radiopharmaceuticals during scitigraphic examination was in area of right submandibular gland. In November 2009 there was executed radionavigated extirpation of parathyroid gland adenoma - adenoma was localized in lower pole of right lobe of thyroid gland.

After operation the level of PTH was normalized, but later the hypercalcemia has continued, temporary with mild increasing of PTH. Based on these laboratory results we assumed the coexistence of another disease, which could participate on hypercalcemia too.

Within differential diagnosis of hypercalcemia there was made complete algorithm of the examinations. At PET/CT expected ectopic hyperplastic parathyroid gland was displayed, but considering of the PTH level we do not assume it is the reason of hypercalcemia.

Considering polyarthritis personal history we executed rheumatologic examination. Within rheumatologic screening the positivity of antibodies ANA, ENA, Ro52, SSA, SSB, SCl 70 was found, but diagnostic criteria of systemic disease were not matched.

Because of polyclonal gammapathy the haematological examination was executed, but the multiple myeloma was not positively proved too. Considering continuing hypercalcemia we add to treatment ex juvantibus the corticosteroids which reduced calcemia under 3 mmol/l.

Hypercalcemia is a common electrolyte abnormality with a wide differential diagnosis. The reason of hypercalcemia is in 90% primary hyperparathyroidism and malignity. In our patient there is no positive reason of hypercalcemia so far. Except above mentioned comes into consideration the autoimmune inflammatory disease, and diagnostic criteria are not matched that time.

Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.