Endocrine Abstracts

JOINT3306

Background: Primary hyperparathyroidism (PHPT) is an underdiagnosed condition with systemic consequences, including cardiovascular disease, nephrolithiasis, and osteoporosis. Routine calcium and parathyroid hormone (PTH) measurement is crucial for early detection. Additionally, ultrasonography plays a key role in localizing parathyroid adenomas. We present three cases highlighting the consequences of delayed diagnosis and the importance of endocrine evaluation.

Case Presentation: Case 1: A 64-year-old female presented for levothyroxine dose adjustment. Neck ultrasound revealed a suspicious adenoma, confirmed by scintigraphy. Laboratory findings showed elevated PTH (310 pg/mL), hypercalcemia, and vitamin D deficiency (18 ng/mL). She had osteoporosis and a significant cardiovascular history, including an aortocoronary bypass and cryoablation for arrhythmias eight years prior. Despite these events, hyperparathyroidism was never suspected, highlighting the potential cardiovascular impact of undiagnosed PHPT.

Case 2: A 57-year-old female with recurrent nephrocalcinosis and multiple ureteral stents due to complications over five years was diagnosed with PHPT. PTH was 160 pg/mL, calcium was elevated, and scintigraphy confirmed an adenoma. She also had osteoporosis, previously misattributed to aging. Earlier diagnosis could have prevented renal and skeletal complications.

Case 3: A female with newly diagnosed Graves’ disease underwent ultrasound, which incidentally revealed a suspicious parathyroid adenoma. Biochemical workup confirmed PHPT with hypercalcemia, and scintigraphy validated the diagnosis. The coexistence of Graves’ disease and PHPT highlights the need for careful endocrine assessment. All patients underwent successful parathyroidectomy, leading to normalization of PTH levels and resolution of hypercalcemia.

Discussion: These cases emphasize PHPT’s systemic effects and its frequent underrecognition in patients with cardiovascular disease, nephrolithiasis, and osteoporosis. The first case underscores PHPT’s potential role in cardiovascular pathology, while the first two cases highlight its impact on bone health. The third case illustrates the importance of evaluating parathyroid glands during thyroid ultrasound. Routine screening for hyperparathyroidism in high-risk patients can prevent severe complications.

Conclusion: PHPT should be considered in patients with unexplained cardiovascular disease, recurrent nephrolithiasis, and osteoporosis. Routine calcium and PTH measurement, alongside careful ultrasound evaluation, is crucial for early detection. Recognizing PHPT at an early stage can significantly improve patient outcomes.