Endocrine Abstracts

We present the case of a 75-year-old woman with a 10-year history of nephrolithiasis, for which she endured several sessions of extracorporeal shockwave lithotripsy (ESWL). She was directed to the Endocrinology unit for further investigations, due to persistent albeit minor increased values of blood calcium (10.48 mg/dl, normal 8.4–10.2 mg/dl). Here, the clinical supposition of primary hyperparathyroidism was confirmed. The tests revealed a mild hypercalcemia with hypophosphatemia (2.25 mg/dl, normal 2.5–4.7 mg/dl) and hypercalciuria (408 mg/24 h normal values 100–300 mg/24 h). Although at advanced age and never been treated for osteoporosis, she had three pathological fractures and very low bone mineral density at all locations, radius included. These antecedents increased the supposition of supplementary metabolic disorder, other than postmenopausis and/or senile status.

PTH levels were abnormally increased (295 pg/ml, normal levels 11–67 pg/ml) and 25HO-D vitamin level was low (10.59 ng/ml, normal >30 ng/ml).

A hypoechogenic well delimited nodule was detected behind the lower pole of the left thyroid lobe. This image overlapped on a region of increased uptake by scintigraphic with sesta-MIBI, confirming the location of a parathyroid adenoma. We recommend the patient minimal invasive surgery and bone protection with bisfosphonates, after which we estimate a favorable evolution.

Primary hyperparathyroidism is a common endocrinologycal disease usually. Its presence is usually explained by hypercalcemia. Delay was due to masked hypercalcemia by vitamin D deficiency.