Endocrine Abstracts

IntroductionVitamin D deficiency is considered as a major public health concern. Due to vitamin D’s crucial role in the intestinal calcium absorption, its deficiency may result in hypocalcemia and in a spectrum of associated clinical manifestations.AimTo assess the effect of 25(OH) vitamin D level (25(OH)D) on the frequency of hypocalcemia episodes and the daily profile of serum calcium and 24-h urinary ...

IntroductionCurrent standard treatment of primary hypoparathyroidism is based on calcium and activated vitamin D supplementation. Iatrogenic severe hypercalcemia due to vitamin D intoxication is an uncommon complication rarely described in literature. Herein we report 5 cases of severe hypercalcemia secondary to vitamin D intoxication.ObservationsThree men and two women with chronic hypoparathyroidism were in...

A pituitary hormonal profile and MRI pituitary was requested revealing eupituitary hormonal status with an incidental finding of 4 mm microadenoma. The case was discussed in local MDT and the outcome was to continue conservative management of PHPTH with cinacalcet until pheochromocytoma has been ruled out completely. Both MEN-1 and MEN-2 are associated with PHPTH. If a patient is having episodic adrenergic crises with inconclusive metanephrines analysis then excluding pheochro...

IntroductionAmicrobial skin pustulosis is one of the exceptional manifestations of hypoparathyroidism. We report 2 observations of a Fahr syndrome secondary to hypoparathyroidism revealed by generalized pustulosis.Observations 124 year old woman, with no history of thyroid surgery, The patient was admitted for generalized covering more than 90% of the body surface. Biology objected to hypocalcemia at 57 mg/l,...

IntroductionParathyroid carcinoma (CaPa) is an extremely rare cause of primary hyperparathyroidism. Patients with CaPa usually present severe hypercalcemia with abrupt bone and renal diseases, neurologic manifestations and gastrointestinal symptoms. However, sometimes the presentation is insidious with nonspecific symptoms and mild hypercalcemia. Surgery is the only curative treatment and after surgery close monitoring of calcium levels are necessary due...

IntroductionParathyroid surgery is indicated essentially in primary and secondary hyperparathyroidism. This surgery may present some difficulties even in experienced hands. Our aim is to describe the difficulties that can occur during parathyroid surgery.Material and methodsA retrospective study including 81 cases of hyperparathyroidism, operated between 2001 and 2018.Results<p clas...

CaseMale, 44 y.o., with rigth maxillary tumor of progressive growth for 1 year with local and low back pain. Imaging exams: CT/MRI skull and face: right axial expansive lesion (62×52×46 mm), heterogeneous, multiloculated with bulging of the right orbit inferomedial wall, with a neoplastic aspect. CT pelvis: bone lesions with soft tissue densities in pelvis, heterogeneous L4, with height reduction. Biopsy of the lesion suggesting a brown tumor. ...

IntroductionThe atypical parathyroid adenoma is a histological diagnosis. It is a parathyroid tumor with atypical histological features different from an adenoma and not similar enough to be considered as a carcinoma.It has an uncertain malignant potential.ObservationWe report the case of a 55 year-old woman, referred to us by her rhumatologist after discovering a severe hypercalcemia when exploring her for o...

BackgroundMost cases of primary hyperparathyroidism (PHPT) is caused by a single benign adenoma, multiple parathyroid neoplasms (MPN) occur less often in 10–15%, parathyroid carcinoma accounts for <3%. MPN can be sporadic or develop due to inherited genetic syndromes (most commonly multiple endocrine neoplasia syndrome type 1 (MEN-1) that usually manifest at a young age. The preoperative examination of patients with MPN is important for achievin...

IntroductionParathyromatosis is a potential cause of recurrent hyperparathyroidism, of rare etiology, described as multiple nodules of hyperfunctioning benign parathyroid tissue, it constitutes less than 1% of the cases of recurrent hyperparathyroidism and since its description in 1975, less than 40 cases have been reported Worldwide. The presentation in primary hyperparathyroidism is extremely rare, with around 20 cases reported in the English literatur...

BackgroundSecondary hyperparathyroidism is a condition that can occur as a result of low vitamin D level. Parathyroid hormone (PTH) has the role of stimulating bone resorption by two mechanisms: direct activation of osteoblasts and indirect stimulation of osteoclast. Exostosis or bone spur is a benign tumor that consists in overgrowth of a pre-existing bone. Exostoses can affect any bone, however they are most commonly located on the bones of the joints ...

Familial hypocalciuric hypercalcemia is a rare clinical condition of persistently elevated serum calcium and reduced urinary calcium levels with an autosomal dominance inheritance pattern to the three out of four large types of this condition known. This rare condition goes largely undiagnosed as patients are largely asymptomatic and where symptoms are present, other causes of hypercalcaemia are considered first. Hyperparathyroidism, super-imposing on FHH, is an even rarer occ...

IntroductionJacobsen syndrome (JS) is a rare gene disorder caused by a terminal deletion of the long arm of chromosome 11. The estimated prevalence of Jacobsen syndrome is 1/100.000 births. It is most commonly presented with psychomotor and physical growth retardation, dysmorphic facial features, thrombocytopenia or pancytopenia. It is also characterized by congenital heart defects, and kidney, gastrointestinal tract, genitalia, CNS and skeletal deformit...

BackgroundCystic parathyroid adenoma is a rare entity (<0.01% of all cervical masses) that leads to primary hyperparathyroidism in 9% of cases. Parathyroid scintigraphy is essential for the diagnosis although there are pitfalls with false negative results. Parathyroidectomy is the treatment of choice but its success depends on the exact preoperative localization of the parathyroid lesions. 4D-CT is a very helpful diagnostic tool in such cases.<p ...

IntroductionPseudohypoparathyroidism (PHP) is the first example of hormonal resistance observed in human pathology characterized by a great variability of clinical and genetic expression. We present a case of PHP in a Tunisian family.ObservationThe index case is a 31-year-old man. He was burn out of a consanguineous marriage (distant consanguinity) followed since the age of 15 for convulsive seizures. Three m...

BackgroundPrimary hyperparathyroidism (PHPT) results from inappropriate overproduction of parathyroid hormone from one or more of parathyroid glands with consequent hypercalcemia. Medical therapy by bisphosphonates is indicated for patients contraindicated for surgical treatment or those with therapy failure. We report the observation of a patient receiving zoledronic acid for persistent PHPT and who developped bisphosphonate-related osteonecrosis of the...

IntroductionThe association between vitamin D deficiency and primary hyperparathyroidism( PHP) has clear implications. Co-existing vitamin D deficiency may cause the serum calcium level to fall into the normal range, which can lead to diagnostic uncertainty. The objective of this study is to assess the vitamin D status of patients followed for primary hyperparathyroidism.Materials and methodsThis is a retrosp...

Osteoporosis is a systemic skeletal disease characterized by a decrease in bone strength and an increased risk of fractures. In the structure of osteoporosis, secondary osteoporosis is 5% in women and 20% in men. Clinicians need to exclude the secondary nature of osteoporosis, since under the ’mask’ of mineral metabolism disorders, more rare and dangerous diseases can arise. A 65-years-old women presents with complaints of three low-traumatic fractures in the last ye...

Traditionally, patients diagnosed with primary hyperparathyroidism present with mild hypercalcaemia and tend to be asymptomatic. Symptomatic patients tend to have severely high calcium and exhibit the classic ’bones, stones, abdominal moans and psychic groans.’ We present a case of a 92-year-old Caucasian gentleman presenting with recurrent falls, postural hypotension and trauma to head and shoulder. X-ray imaging showed small non-specific lucencies in the cervical a...

Key wordsGPA, granulomatosis, serum, 24 h urine, calcium.IntroductionGranulomatosis with polyangiitis (GPA) is a very rare systemic disease of unknown etiology that is defined by the formation of granulomas in different organ systems. Due to this pathology, there may be an increase in serum and 24 h urine calcium that can have a clinical impact on the course of the disease.Aim<p cla...

IntroductionIt has been estimated that prevalence of vitamin D deficit (25(OH)D) in the world is between 20 and 100%, depending on age group, ethnicity and region. In European population, the prevalence is around 40%. The Endocrine society guidelines recommend the supplementation of vitamin D when vitamin D deficiency is confirmed. The objective of this work is to evaluate the effect of 25(OH)D supplementation on phospho-calcium metabolites: calcium (Ca)...