Endocrine Abstracts

JOINT44

Introduction: Recurrent nephrolithiasis is a frequent pathology often associated with significant morbidity. Among its underlying causes, primary hyperparathyroidism (PHPT) is notable for its contribution to stone formation and nephrocalcinosis. However, PHPT remains an underdiagnosed yet treatable condition, necessitating heightened awareness for timely diagnosis.

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. The patient was admitted for a deep vein thrombosis (DVT) of the right lower limb and initiated on anticoagulation therapy. Etiological investigations 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. Renal imaging showed bilateral hydronephrosis secondary to renal calculi. Localization studies identified a 20×14 mm left inferior parathyroid nodule, confirmed as pathological on MIBI scintigraphy. A surgical referral was made for definitive management.

Discussion: PHPT is a significant cause of recurrent nephrolithiasis, responsible for up to 7% of cases. Hypercalcemia and hypercalciuria, hallmark features of PHPT, promote calcium stone formation. Evidence suggests that delayed diagnosis of PHPT, often exceeding six years from the onset of symptoms, exacerbates renal damage. Studies underline the importance of metabolic assessments in patients with recurrent urolithiasis to identify PHPT early. Surgical intervention, typically parathyroidectomy, is curative, with a marked reduction in stone recurrence postoperatively. In our case, the presence of bilateral hydronephrosis further emphasizes the burden of undiagnosed PHPT. Regular follow-up and management of residual risk factors, such as vitamin D deficiency or low urinary citrate levels, are critical for long-term outcomes.

Conclusion: This case highlights the strong association between PHPT and recurrent nephrolithiasis. Comprehensive metabolic workups in patients with urolithiasis are crucial to prevent delayed diagnoses and their complications. Early surgical management remains the cornerstone of treatment, reducing recurrence and preserving renal function.