Endocrine Abstracts

JOINT2856

Introduction: Primary hyperparathyroidism is a common endocrine disorder of calcium metabolism characterized by hypercalcemia and elevated or inappropriately normal concentrations of parathyroid hormone. Almost always, primary hyperparathyroidism is due to a benign overgrowth of parathyroid tissue either as a single gland (80% of cases) or as a multiple gland disorder (15–20% of cases). Most of patients with PHPT are asymptomatic, but the symptoms and signs could include nephrolithiasis, osteitis fibrosa cystica, osteoporosis, fractures, bone pain, myopathy, and neuropsychiatric impairment. Primary hyperparathyroidism can be cured by removal of the parathyroid gland or glands but identification of patients who are best advised to have surgery requires consideration of the guidelines that are regularly updated. 1.

Case Report: 77 y/o female was hospitalized in our clinic. During hospitalization, performed lab tests revealed significantly elevated serum calcium (x2 ULN) and elevated PTH 20-fold. Thyroid US demonstrated parathyroid tumor suspicious for Cr measuring up to 4 cm and multinodular goiter with total thyroid volume of 25 cm3. During physical examination patient was demonstrating spasticity, lethargy, anxiety, confusion. Patient had a history of ischemic stroke – 2018, PE Arterial hypertension was diagnosed 10 years ago. Patient admitted to have increasing blood pressure findings, renal insufficiency was also diagnosed couple months ago, but no further diagnostic or treatment interventions were initiated. 10 days leading up to hospitalization patient admitted to have had lower and upper extremity tremors. She admits to having these symptoms occasionally. Decreased appetite, severe constipation were also noted. Patient had trouble moving around and was brought in by her family members. Laboratory findings also revealed sublinical hyperthyroidism, suspicious for toxic multinodular goiter. Parathyroidectomy was planned along with the total thyroidectomy. Surgery used intraoperative recurrent laryngeal nerve monitoring device, which revealed low impulse during surgical exploration of parathyroid tumor, instead of additional total thyroidectomy, only subtotal parathyreidectomy was performed considering potential risks associated with recurrent laryngeal nerve compromise.

Conclusion: High level of clinical suspicion and routine laboratory work-up for screening purposes is required for timely diagnosis of hyperparathyroidism. The evaluation and management of patients with parathyroid disease remains challenging, and surgical treatment requires experience and expertise. It’s important to perform vertebral and renal imaging in addition to bone desitomety followed by corresponding treatment if required.

Reference: 1. John P Bilezikian, Leonardo Bandeira, Aliya Khan, Natalie E Cusano Lancet 2018; 391: 168–78