Endocrine Abstracts

A 71-year-old man presented with a three week history of nausea, vomiting, constipation, polyuria, nocturia, polydipsia and feeling weak. He had sustained a wrist fracture six weeks prior to admission. Since then he had started to consume calcium containing mineral water, cod liver oil and seven seas oil.

Examination revealed a palpable mass in the right lower thyroid. Serum calcium level was 4.37 millimols/litre (ref. 2.10-2.70), parathormone level of 72picomols/litre (0.4-4.3) and a low phosphate. Vitamin D level was 8.1 micrograms/litre (ref. 4-40). Serum albumin was 41 grams/litre (ref. 32-50), serum creatinine 132 micromols/litre (ref. 40-124).

He was rehydrated with intravenous fluids. Calcium supplements were stopped. His calcium levels improved to 3.63 millimols/litre and he felt much better in himself. His renal functions returned to normal.

An ultrasound of the neck revealed a 4 cm mass behind the right lower lobe of the thyroid which was confirmed on the MRI scan of his neck.

Parathyroidectomy was performed with per-operative one alpha calcidol treatment. Parathyroid gland weighing 13.47 grams was removed and histopathology was consistent with an adenoma. His serum calcium and parathormone levels returned to normal within twenty-four hours.

Conclusion: This case of severe hyperparathyroidism was confounded by the patient's history of consuming excessive calcium supplements and vitamin D based on the belief that it would help keep his bones stronger after sustaining a fracture. A large number of people are influenced by the advertisement on foods and drinks, which may be misleading and at times detrimental to their health. It would hence be worth exercising a caution before the lay population uses such products.