Endocrine Abstracts

Introduction: Primary hyperparathyroidism affects 0.3% of the general population1. 90% are due to single parathyroid adenoma1. Surgical treatment is the only definitive cure2. Improvements in imaging permit radiologists to better identify parathyroid adenomas1, enabling more targeted surgery1, thus shortening general anaesthesia, as well as lowering post-operative complication rates. Neck ultrasound (US) and parathyroid sc...

Vitamin D is a pleotropic hormone with important actions in a wide variety of cell types. Whilst its role in the endocrine control of calcium metabolism via the active circulating metabolite 1,25- dihydroxy cholecalciferol is widely appreciated, other actions in a range of cells and tissues depend on activation of circulating 25-hydroxy vitamin D by intracrine mechanisms and paracrine actions which may be locally controlled. Of particular interest are the roles of vitamin D pe...

Introduction: MRONJ is defined as exposed bone in the maxillofacial region that persists after eight weeks in patients treated with antiresorptive or anti-angiogenic drugs, without previous radiotherapy. The estimated United Kingdom incidence of MRONJ in osteoporosis patients is 0.01-0.1% (1). MRONJ can cause severe disfigurement, speech and feeding difficulties. We aim to investigate MRONJ incidence and utility of dental screening in patients receiving Zoledronate ...

Background: Primary Hyperparathyroidism is a leading cause of hypercalcaemia and is frequently asymptomatic. Due to its long-term complications, early diagnosis and management is essential. NICE published guidelines on diagnosis and management of Primary Hyperparathyroidism in May 2019. The aim of this audit was to compare our existing practices against NICE guidance.Methods: We conducted retrospective data collection by identifying patients diagnosed wi...

Background: Vitamin D is important for calcium homeostasis. In granulomatous diseases including tuberculosis (TB), hypercalcaemia may be seen. Suspected mechanisms include elevated vitamin D sensitivity and increased extrarenal synthesis of 1,25-dihydroxyvitamin D [1,25(OH)2D] by alveolar macrophages within granulomas. Prevalence of hypercalcaemia in TB patients vary worldwide, yet is rare in the UK. We present a case of hypercalcaemia in a patient with TB reactivat...

Introduction: Cinacalcet is an allosteric modulator of the calcium sensing receptor which lowers parathyroid hormone (PTH) secretion. However, it is expensive and there is limited evidence of benefit in reducing complications of primary hyperparathyroidism (PHPT). In 2019 the National Institute for Health and Care Excellence (NICE) guidelines suggested that cinacalcet could be considered in individuals with PHPT if surgery has been unsuccessful or is unsuitable and if adjCa<su...

The partum period can be seen as a transient condition of “menopause” due to the physiological decline to a baseline of the high estrogens found during pregnancy, and bone metabolism is likely to alter. Moreover, high calcium requirements for fetal growth and during breastfeeding are covered in the maternal metabolism from enhanced intestinal absorption in a Calcitriol dependent pathway, and maternal bone reabsorption under control of parathyroid hormone (PTH) parath...

We report the case of a 63-year-old lady with refractory hypocalcaemia due to surgical hypoparathyroidism, decompensated by malabsorption following gastric bypass, successfully treated with recombinant human parathyroid hormone 1-84 (rhPTH), Natpar. She initially presented with medullary thyroid cancer aged 33 and was found to have MEN2A. She underwent thyroidectomy and developed post-surgical hypoparathyroidism. She was managed for over 20 years with alfacalcidol and oral cal...

Introduction: There are reports of patients having co-existing primary hyperparathyroidism and familial hypocalciuric hypercalcaemia (FHH). The combination of relative hypocalciuria, hypercalcaemia and slightly elevated serum parathyroid hormone (PTH) could indicate FHH. Medications such as, lithium and bendroflumethiazide can reduce renal excretion of calcium. We report a case highlighting the importance of being aware of drug-induced hypocalciuria during the investigation of...

Introduction: Hypercalcemia has a broad differential, including primary hyperparathyroidism, non-parathyroid hormone-mediated hypercalcemia, including humoral hypercalcemia of malignancy, or medication mediated. We report a case of severe hypercalcemia attributable to milk-alkali syndrome due to excessive calcium carbonate use.Case: A 71 year-old female with a history of hypertension presented after a fall without loss of consciousness. She endorsed epis...

Introduction: Vitamin D is a potential immune modulator and low levels are common in inflammatory bowel disease (IBD) patients. The aim of the study was to determine the association between deficient vitamin D and inflammatory profile.Methods: Intestinal (fecal calprotectin) and blood inflammatory profile [erythrocytes sedimentation rate (ESR), protein C reactive, fibrinogen], were performed to all patients. In addition, level of 25 hydroxy vitamin D was...

Purpose: To evaluate long-term safety and efficacy of cinacalcet in management of primary hyperparathyroidism (PHPT).Material/Methods: We retrospectively studied all patients on cinacalcet for primary hyperparathyroidism over 3 year’s period. Data was collected and analyzed for indication, daily maintenance dose, tolerability, biochemical effect at 3, 6 and 12 months, effect on bone mineral density and renal stone disease. This study excluded those ...

A 29 year-old nursing student, was incidentally detected to have high serum calcium 3.43 mmol/l (2.2-2.6) whilst being treated for community acquired pneumonia. She had no symptoms of hypercalcaemia. Her uncle had been operated for primary hyperparathyroidism (PHPT) although only limited details were available. PTH of 28 pmol/l (1.6-7.2) confirmed the diagnosis of PHPT. She had vitamin D deficiency, normal liver and renal function. She was offered parathyroidectomy and preoper...

Introduction: Immobilization hypercalcemia is uncommon condition associated with limited movements following brain and spinal cord lesions. Immobilization results in stimulation of osteoclastic bone resorption hypercalciuria and hypercalcemia.Case report: 57 year female, Background of Breast Cancer (Treated with Skin sparing mastectomy and adjuvant radiotherapy) admitted following large subdural hematoma leading to craniotomy and evacuation of hematoma. ...

Background, case-history: Hypercalcaemia secondary to parathyroid hormone (PTH) independent mechanisms is well known, with differentials including Sarcoidosis. We describe a case of Sarcoid Myositis presenting with symptomatic hypercalcaemia (adjusted serum calcium levels of 3.12 mmol/l) but no muscle weakness in a 39-year-old lady with a background of Type 1 Diabetes Mellitus, Hyperthyroidism, and Rheumatoid Arthritis.Investigations: Laboratory investig...

Introduction: Primary parathyroid carcinoma accounts for less than 1% of the parathyroid gland tumours and almost always presents as primary hyperparathyroidism. Very few Turner syndrome patients have been reported so far to present with primary hyperparathyroidism secondary to parathyroid adenoma. We report a case of parathyroid carcinoma in a 59 years old lady with Turner syndrome who is presenting with recurrent mild hypercalcemia.Case presentation: A...

Background: Autoimmune polyglandular syndrome type 1 (APS-1) is an autoimmune inherited disorder, a potentially underdiagnosed clinical entity, caused by mutations in the autoimmune regulatory gene that can present with varying symptomatology as it affects various organs, posing both a diagnostic and management hurdle. We report a case to highlight this complexity.Case report: Case details involves a female who first presented in childhood with rash, eye...

A 25 year old Afghan male presented with a 4 day history of worsening left-sided loin pain. He had a past history of deafness since birth, speech problems and development delay. Bilateral renal calculi and widespread multiple well defined lytic lesions (likely brown tumours) were seen on CT-KUB. The corrected calcium was 3.21 mmols/l, PTH 80 pmol/l, Vitamin D 25 nmol/l, phosphate 0.49 mmols/l, ALP 960 IU/l and fractional calcium excretion was 0.16. His skull X Ray/OPG, done du...

Primary hyperparathyroidism (PHP) is the most common aetiology for hypercalcaemia. Its prevalence in pregnancy is reported to be between 0.15% and 1.4%[i][ii]. It presents a threat to the health of both mother (hyperemesis, nephrolithiasis) and foetus (foetal death, congenital malformations, neonatal severe hypocalcaemia induced tetany)[iii][iv]. However, there is a lack of clear guidance on management of primary hyperparathyroidism in pregnancy. We describe the ...

Spontaneous resolution of primary hyperparathyroidism following infarction for parathyroid adenomas is rare with infarction on treatment with cinacalcet being even rarer. A 53 year old female who presented to primary care with malaise was found to have biochemical evidence of primary hyperparathyroidism with adjusted calcium 3.31 mmol/l and parathyroid hormone 28.8 pmol/l. Previous medical history was unremarkable. Following discussion with endocrinology, treatment with cinaca...

Introduction: Vitamin D toxicity (VDT) is quite an uncommon condition which results from misperception between dosage regimens of vitamin D supplementation. VDT is diagnosed when Serum 25-hydroxyvitamin D levels are higher than 375 nmol/l (150 ng/ml). Vitamin D supplementation is easily accessible as over-counter medication and online. This report describes a patient who presented with severe hypercalcemia and acute kidney injury (AKI). Further assessment revealed that patient...

Introduction: Primary hyperparathyroidism is associated with numerous cardiovascular complications including hypertension, left ventricular hypertrophy and calcification of cardiac valves. However NICE have not included cardiovascular complications as an indication of parathyroidectomy. This literature review will be focused on benefits of parathyroidectomy on cardiovascular complications of primary hyperparathyroidism.Methodology: Literature search done...