Endocrine Abstracts

Introduction: The report describes the case of a late-diagnosed primary hyperparathyroidism in the patient, who developed catastrophic renal complications and such advanced osteoporosis, that hungry bone syndrome occurred after removal of parathyroid adenoma.

Case report: A 63-year-old woman with long-lasting nephrolithiasis was admitted to the hospital due to high PTH discovered in a routine laboratory testing. She had undergone left-side nephrectomy 2 years before admission due to hydronephrosis. In the last year she lost 5 kg and suffered from asthenia, joint-pain and recurrent infections of the urinary tract. Laboratory tests during hospitalisation confirmed significantly raised PTH (2070 pg/ml), ALP (1047 IU/l), total calcium, and ionized serum calcium (3.26 and 1.91 mmol/l respectively). Also, anaemia (Hb, 8.8 g%) was observed and serum creatinine was substantially deteriorated (2.12 mg/dl, GFR 19 ml/min). Calcium (92.4 mg) and phosphate (367 mg) urine excretion in 24 h collection and 25(OH)D3 (17 ng/ml) were under normal range. Neck ultrasonography demonstrated multinodular goitre (thyroid function tests were normal). The biggest nodule was in the right thyroid lobe, it was hypoechogenic and had 20×16×24 mm diameter. 99mTc-sestamibi scintigraphy detected abnormal lower right parathyroid gland. DXA osteodensitometry showed advanced osteoporosis (−4.8 S.D. lumbar and −3.6 S.D. femoral neck T-score). During the parathyreoidectomy rapid decrease of serum PTH was observed (to 150 pg/ml). Two months postoperatively patient developed hypocalcaemia (1.93 mmol/l) and again high level of PTH (946 pg/ml). The diagnosis of hungry bone syndrome was made. The treatment with vitamin D, calcium supplementation, and alendronate sodium was started, which resulted in a gradual decrease in PTH and normalization of serum calcium.

Conclusion: In each case of nephrolithiasis the probability of hyperparathyroidism should be checked, otherwise it can lead to irreparable damages of human organism.