Endocrine Abstracts

Introduction: Calciphylaxis is a rare, life-threatening condition associated with hypercalcaemia. It is characterised by calcification of small and middle-sized arterioles within subcutaneous tissue, leading to compromised blood flow, tissue ischaemia and subsequent necrosis. While calciphylaxis typically occurs in chronic kidney disease (CKD), a small proportion of cases can present without CKD, referred to as non-uraemic calciphylaxis (NUC). Cases of NUC associated with primary hyperparathyroidism are rarely documented. Additionally, evidence-based management options for NUC in the context of hyperparathyroidism remain limited due to the rarity of the condition.

Case report: We present a case of an individual admitted following out-of-hospital cardiac arrest. She was previously healthy prior to this. Following successful resuscitation, the investigations revealed significantly high calcium levels at 4.46 mmol/L along with raised PTH at 261.2 pmol/l in keeping with primary hyperparathyroidism. After stabilization, she underwent an urgent parathyroidectomy with histopathology revealing a benign parathyroid adenoma. Notably, she had no history of hypercalcaemia symptoms before this event. Postoperatively, her calcium levels and parathyroid levels significantly dropped to 2.09mmol/L and 0.3 pmol/l respectively. Following her parathyroidectomy, she had a prolonged post-surgery recovery in the intensive care unit (ITU). She developed severely painful lesions in her groin and axilla regions. This were promptly reviewed by a dermatologist and biopsied. Histopathology confirmed the diagnosis of calciphylaxis. She was closely monitored, received regular wound debridement and early mobilisation with physiotherapy. Her calcium levels remained stable throughout her recovery period.

Conclusion: Calciphylaxis is a life-threatening condition, primarily affects patients who have chronic renal failure. A small proportion of patients of cases have been documented in the absence of renal disease known as non-uremic calciphylaxis. Patients who have undergone parathyroidectomy for primary hyperparathyroidism should be recognised as a potential risk factor for NUC. Early recognition and prompt treatment are critical for improving mortality outcomes in calciphylaxis.