Endocrine Abstracts

We present an unusual case of longstanding hypoparathyroidism, for which a diagnosis was eventually reached at the age of 92 yrs. The patient presented in 2014 aged 83 years with symptomatic hypocalcaemia – corrected calcium was 1.1 mmol/L and PTH was 1.8 pmol/l. He was referred to our department in 2017 when it was noted he had a background of chronic kidney disease, hypertension, Paget’s disease of the skull and a mild normocytic anaemia. The mild anaemia had been ongoing since 2010 when a level of 128 g/L was investigated and showed raised ferritin 423 ug/L (normal range 15-300), iron 34 umol/L (normal range 9 - 28) and transferrin saturations 65% (normal range 20-55). However, this was not noted at the time of his referral. The patient was reviewed annually in clinic, calcium and vitamin D supplementation were ongoing, and his corrected calcium level remained stable at 1.94- 2.28 mmol/L during the period of 2017-2024. In 2024 at the age of 92, it was noted that he seemed clinically hypogonadal with little in the way of facial hair, unwrinkled complexion and a full head of scalp hair. This prompted a testosterone check which revealed a low level of 4.0 nmol/l (normal range 6.7 – 25.7) with an FSH of 28.9 IU/L and LH of 20.3 IU/l. His alkaline phosphatase was raised at 218u/L (normal range 30-130) and this had been the case from 2010, due to Paget’s disease. His ALT was normal. His iron studies were requested and they revealed a similar picture to before with raised ferritin, iron and transferrin saturations. Genetics were sent for hereditary haemochromatosis which were homozygous for the pathological variant C282Y. Idiopathic hypoparathyroidism is a dissatisfying diagnosis and a cause may only be apparent if appropriate investigations are made.