Introduction: Subcutaneous calcinosis are deposits of hydroxyapatite crystals in the skin. They are hard masses, poorly organized, located most often in the dermis or hypodermis. They are secondary to either local tissue alterations or the penetration of calcium salts into the skin, or to an abnormal phosphocalcic metabolism but which remains an exceptional complication in case of primary hyperparathyroidism. We report the case of a patient admitted to the endocrinology department for chronic hypercalcemia whose clinical and para-clinical exploration reveals primary hyperparathyroidism with subcutaneous calcinosis.
Observation: A 27-year-old female patient, was admitted in our department for etiological assessment of chronic hypercalcemia with a pathological fracture of the right femur and acute renal failure. Clinical examination found subcutaneous hard, painless, non-inflammatory nodules at the 2 elbows and at the lower gum. The elbow radiography showed radiopaque structures in favor of subcutaneous calcinosis. The etiological investigations of hypercalcemia was in favor of primary hyperparathyroidism. The evolution was marked by the decrease of the size then the disappearance of the lesions after normalization of the phosphocalcic balance after a symptomatic treatment.
Discussion: Subcutaneous calcinosis is rarely reported in primary hyperparathyroidism. Indeed, hyperphosphoremia is the main factor involved in the development of these subcutaneous calcinosis in the context of phosphocalcic disturbances, regardless of the level of hypercalcemia. Lesions tend to resolve spontaneously when calcium and phosphate levels normalize.
18 - 21 May 2019
European Society of Endocrinology