Endocrine Abstracts

JOINT288

Background: Fibromyalgia is a chronic diffuse pain syndrome characterized by widespread musculoskeletal pain, chronic fatigue, and sleep disturbances. These symptoms overlap with those commonly observed in hyperparathyroidism, a condition that may also present with neuropsychiatric and musculoskeletal complaints. Understanding the interplay between these two conditions could provide valuable insights into their pathophysiological mechanisms and diagnostic challenges.

Case Report: We present the case of a 49-year-old woman with a history of treated breast carcinoma, admitted to the endocrinology department for evaluation of hypercalciuria. The patient exhibited anxiety, irritability, and a focus on multiple somatic complaints, including asthenia, headaches affecting sleep quality, diffuse muscle pain, fatigue, and morning stiffness. She reported an exacerbation of pain with heat and stress, although her appetite remained intact. Symptoms persisted despite treatment with non-steroidal anti-inflammatory drugs and antidepressants. The patient underwent multiple specialist consultations, and a brain MRI revealed nonspecific white matter hyperintensities. Clinical examination identified 11 tender points out of 18 according to the American College of Rheumatology (ACR) criteria, leading to a diagnosis of fibromyalgia. Further investigations suggested a likely diagnosis of normocalcemic primary hyperparathyroidism, supported by a serum calcium level of 2.44 mmol/l, a phosphate level of 0.7 mmol/l, an inappropriately elevated parathyroid hormone (PTH) level of 166.60 pg/mL and a urinary calcium excretion of 11.22 mmol/24h. Neck ultrasound revealed a left parathyroid nodule measuring 10 × 7 × 2 mm, and bone densitometry confirmed osteoporosis. Other potential causes of hypercalciuria, such as granulomatous diseases, were ruled out.

Conclusion: The diagnosis of fibromyalgia is frequently delayed, leading to a significant socio-economic burden due to prolonged symptomatology and repeated medical consultations. In this case, the coexistence of fibromyalgia and hyperparathyroidism underscores the importance of a thorough diagnostic approach to unexplained chronic symptoms. Further research is essential to clarify the potential pathophysiological connections between these two conditions and optimize patient management.