Clot twist: deep vein thrombosis uncovers primary hyperparathyroidism

Kassi Nada Ait; Taleb Chaimae; Habbadi Zineb; Fatima Toulali; Ghizlane Sabbar; Kaoutar Rifai; Hinde Iraqi; Hassan Gharbi Mohamed El

doi:10.1530/endoabs.110.EP261

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Endocrine Abstracts (2025) 110 EP261 | DOI: 10.1530/endoabs.110.EP261

ECEESPE2025 ePoster Presentations Bone and Mineral Metabolism (142 abstracts)

Clot twist: deep vein thrombosis uncovers primary hyperparathyroidism

Nada Ait Kassi ¹ , Taleb Chaimae ² , Habbadi Zineb ¹ , Fatima Toulali ² , Ghizlane Sabbar ² , Kaoutar Rifai ² , Hinde Iraqi ² & Mohamed El Hassan Gharbi ²

Author affiliations

¹Ibn Sina Hospital Mohamed V University, Endocrinology, Rabat, Morocco; ²Ibn Sina Hospital Mohamed V University, Endocrinology, Rabat, Morocco

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Introduction: Primary hyperparathyroidism (PHPT) is an endocrine disorder characterized by hypercalcemia, leading to various systemic complications. Recent evidence suggests a potential link between hypercalcemia and an increased risk of venous thromboembolism (VTE), an association warranting further exploration.

Case Presentation: We report the case of a 47-year-old male with a history of recurrent nephrolithiasis treated by extracorporeal shock wave lithotripsy in 2019. He was admitted for a deep vein thrombosis (DVT) of the right lower limb and initiated on anticoagulation therapy. Workup revealed PHPT with serum calcium of 107 mg/l, phosphorus of 18 mg/l, parathyroid hormone (PTH) levels 5.5 times the normal limit, and elevated 24-hour urinary calcium excretion. Complications included bilateral hydronephrosis secondary to renal calculi, osteolytic lesions, and osteoporosis in the lumbar spine and right femur. Cardiovascular evaluation was unremarkable. Cervical ultrasound identified a 20×14 mm left inferior parathyroid nodule, confirmed on MIBI scintigraphy. A multiple endocrine neoplasia (MEN) workup was negative. The patient was referred for surgical management.

Discussion: Recent studies, including large-scale investigations, highlight PHPT as an independent risk factor for acute VTE. Elevated calcium levels in PHPT patients may activate the coagulation cascade, increasing the propensity for thrombosis. In our case, the temporal association between PHPT and DVT reinforces this link. Early identification and treatment of PHPT can mitigate thrombotic risk, emphasizing the importance of integrating calcium-related disorders into VTE risk stratification models.

Conclusion: This case illustrates the multifaceted complications of PHPT, including its potential role in venous thromboembolism. Surgical intervention remains the cornerstone for resolving PHPT and reducing systemic complications. Further studies are needed to establish standardized guidelines for managing thrombotic risks in PHPT patients.