Endocrine Abstracts

A 67-year male presented to his GP with polydypsia, ployuria and bone pains. Routine blood tests showed hypercalcemia (corrected calcium 2.77 mmol/l). Patient was otherwise well. He had a history of ethanol abuse, hypertension and gout.

Medications: Allopurinol, ramipril simvastatin and co-dydramol. Repeat blood tests after 4 weeks show a rising calcium of 3.24 mmol/l with intact PTH 33.6 pmol/l (<6.4). He was referred to our endocrinology department after initial treatment on MAU with i.v. fluids.

Relevant investigations: FBC and ESR, U&E, LFT, Vit D levels, CXR were all normal. Serum phosphate low normal (0.75 mmol/l). An ultrasound of the neck followed by a CT neck/chest/mediastinum and Sestamibi scan was normal. Venous sampling was undertaken but this did not localize an adenoma. He was posted for parathyroid exploration and pre operative assessment bloods, done 5 months after initial diagnosis, showed calcium has returned to normal (2.37, PTH reverting to normal 7.7). Patient remained well and was discharged by surgeons. Three months later repeat blood tests (patient remains asymptomatic and well) show calcium is rising again to 2.66 with an elevated PTH 16.5.

Discussion: Although rare, spontaneous resolution of hyperparathyroidism has been occasionally described. The postulation is there is a spontaneous infarction of the parathyroid adenoma resulting in normocalcaemia. However these cases do not recur. In our case there is a recurrence of the hyperparathyroidism with no obvious adenoma during the initial investigations. We are now repeating the venous sampling and arranging further imaging. He may need exploration and parathyroidectomy.