Introduction: Primary hyperparathyroidism (PHPT) is a common endocrine disorder often diagnosed in asymptomatic individuals on routine biochemical screening, which, if left untreated, can have devastating consequences. The main target organs of PTH are the skeletal system and the kidneys. Asymptomatic hypercalcaemia in young adults is uncommon, and patients who remain asymptomatic should be monitored for the development of complications that justify surgery.
Case report: We present a case of a 44-year-old man with bilateral femoral fractures with no previous history of trauma, admitted to the orthopaedic department, requiring surgical management. Initial laboratory testing showed a calcium level of 12.69 mg/dl (adjusted calcium: 13.3 mg/dl), phosphorus level of 3.77 mg/dl, magnesium level of 1.02 mg/dl, elevated alkaline phosphatase of 577 UI/L, and an elevated PTH of 2541 pg/ml. A large right side paratracheal solid mass measuring 3.4 cm was identified on a chest CT scan, multiple pancreatic and kidney calcifications and kidney stones on an abdominal CT scan. An ultrasound scan of the neck showed a right inferior lobe parathyroid adenoma, which was further confirmed by a Sesta MIBI scan. 24-hour calcium excretion was 204 mg/day and he also developed renal failure as a result of nephrocalcinosis. Biochemical testing for Multiple Endocrine Neoplasia types 1, 2 were negative. Surgical management was performed and after removing the right inferior adenoma, the PTH marked a decrease from the initial value to 28.35 pg/ml, however, the patient developed hungry bones syndrome and needed prolonged intravenous calcium.
Conclusions: This case highlights the importance of early detection and management of hyperparathyroidism with the aim of preventing long-term complications. This young man, probably had hyperparathyroidism for a long-time undetected which has resulted in these severe complications. The orthopaedic and renal complications of hyperparathyroidism could have been avoided with early detection and treatment of the hyperparathyroidism.
Keywords: Pathologic fractures, nephrocalcinosis, parathyroid adenoma, Primary Hyperparathyroidism, serum calcium.
18 - 21 May 2019
European Society of Endocrinology