Endocrine Abstracts

Objective: We present a case of primary hyperparathyroidism awaiting surgery that has probable spontaneous resolution lasting only 4 months, supposedly because of asymptomatic infarction or haemorrhage. Her PTH has risen again though her Ca is still normal. Two such cases have been described in the literature.

Case report: A 74-year-old ex-smoker, hypertensive female was admitted with two days history of confusion, lethargy and feeling unwell.

On examination she was severely confused and dehydrated.

Investigations: FBC; Neutrophil leucocytosis

Urea & electrolytes: Na 151 mmol/l, K 3.5 mmol/l, urea 19.0 mmol/l, Creatinine 138 μmol/l Calcium 5.06 mmol/L, Po₄ 1.32 mmol/l, Parathormone 68.3 pmol/l, Vitamin D 87 nmol/l. TSH 0.49 mU/l.

Normal CRP, CEA and Immunoglobulins.

ECG: widespread ST depression, Troponin-I 0.77 (No history of chest pain).

CXR: normal

She was treated for hypercalcaemia with fluids and Pamidronate. A diagnosis of primary hyperparathyroidism was made & tests were were arranged to look for end organ damage.

Dexa scan: T score -3

Ultrasound KUB: normal

Ultrasound & MRI neck: 6×7 mm hypoechoic nodule consistent with parathyroid adenoma.

Sestamibi scan: normal.

As per the guidelines she was referred for parathyroid surgery. Surprisingly her PTH level has dropped from 68.3 originally to 19.7 pmol/l with Ca 2.42 mmol/l in May and PTH 8.8 pmol/l & Ca 2.57 mmol/l in June 2008. But again in October her PTH has risen to 12.9 pmol/l though her calcium 2.58mmol/L is in the normal range.

Conclusion: In literature, we have across only 2 cases of recurrence of spontaneously resolved primary hyperparathyroidism. Our patient presented with high Ca and PTH and became normal for 4 months before her PTH raised again though Ca is still normal. It would be interesting to watch if her PTH will increase further & she becomes hypercalaemic again to warrant re-referral for surgery.