Endocrine Abstracts

This case serves as a critical reminder of the complexities in diagnosing parathyroid disorders and the necessity of personalized management strategies. We present a 36-year-old female with a history of long-standing mental health issues, Type 2 diabetes, and hypertension was referred to our endocrine clinic due to significantly elevated corrected calcium levels of 2.83 mmol/L (normal range 2.2-2.6). The patient was asymptomatic. Her PTH levels were within the normal range but at the upper limit 6.4 pmol/l (normal range 0-6.9). Given her age, hyperparathyroidism is a possibility. Notably, her mother has undergone parathyroid surgery, and both her mother and sister are undergoing genetic testing for MEN syndrome (types 1 or 2), which has returned negative results. A 24-hour urinary calcium test revealed low levels of 1.8 mmol/24h (normal range 2.5-7.5), which is atypical for hyperparathyroidism. Therefore, we are cautious about proceeding with parathyroid surgery until we confirm she does not have familial hypocalciuric hypercalcemia (FHH), a benign condition that typically requires no treatment. Genetic testing for FHH also returned negative. The patient was previously on Dapagliflozin, which we speculated might affect urinary calcium excretion, although this has not been documented before. We advised her to discontinue Dapagliflozin for four weeks and retest her 24-hour urinary calcium. After stopping the medication, her urinary calcium increased to 8.5 mmol/24h. Localization scans indicated a probable right lower parathyroid adenoma, and she has now been scheduled for surgery. In summary, this case underscores the importance of thorough evaluation and genetic testing, particularly given her family’s history of parathyroid disease. The subsequent resolution of her urinary calcium levels after medication adjustment further illuminates the interplay between pharmacotherapy and calcium metabolism.