Endocrine Abstracts

Introduction: Vitamin D deficiency is common in ethnic minority population living in UK. It is a relatively easily treatable condition. However, if left untreated it may lead to chronic secondary hyperparathyroidism and onto tertiary hyperparathyroidism. We report three cases of severe vitamin D deficiency who presented with hypercalcaemia.

Cases

We report three patients. 60 and 46 years old ladies, both of south-asian origin, a 46 years old man of Somalian origin referred to the endocrinology services with severe hypercalcaemia. Referred calcium levels were 3.20, 3.79 and 2.98 mmol/l respectively. Parathormone (PTH) levels were 625, 890 and 639 pg/ml. Vitamin D levels 11, <10 and 7 nmol/l (normal 70–250). PTH levels were 484, 532 and 234 pg/ml respectively after high dose colecalciferol replacement. Calcium levels did not change significantly.

Imaging

Single left ectopic inferior parathyroid adenoma in the first lady on NM parathyroid MIBI scan. Left superior, left inferior and the ectopic left inferior parathyroid glands were removed at surgery. Postoperative calcium was 2.47 mmol/l and PTH was 32 pg/ml.

A right single inferior parathyroid adenoma was identified on the NM Parathyroid MIBI scan in the second lady. A right inferior parathyroid adenoma was removed. Postoperative calcium was 2.44 mmol/l and a parathormone level 33 pg/ml.

The gentleman had a left superior and a right inferior ectopic parathyroid detected on USS and NM parathyroid MIBI scan. He is awaiting surgery.

Discussion: Tertiary hyperparathyroidism (TPHT) has been commonly associated with renal transplant and end stage renal failure patients. Here we present three cases of THPT which we believe were secondary to untreated chronic severe vitamin D deficiency. Vitamin D deficiency is a fairly common condition particularly in the ethnic minority population in the UK, both men and women. Early recognition and treatment of this condition could prevent the progression to THPT and save surgical intervention and thus reducing significant healthcare cost.