Endocrine Abstracts

A 52-year-old male patient first presented in 2007 with symptoms of polyuria, polydipsia and muscle pains. Initial investigations revealed a corrected Ca2+: 3.45 mmol/l and PTH: 168 pmol/l. He was also vitamin D depleted so a diagnosis of severe primary hyperparathyroidism on a background of vitamin D deficiency was made and further investigations were requested to confirm the diagnosis. Unfortunately, the patient failed to attend all subsequent follow up appointmen...

Parathyroid cysts (PCs) are rare lesions usually found during exploration of neck and mediastinal masses. Ten percent of PCs can be functional and release parathyroid hormones causing hypercalcemia. Most PCs are small but lesions greater than 1 cm can exert pressure effects on adjacent structures\. Diagnosis can be challenging as PCs can mimic thyroid masses with no focal tracer uptake during most functional imaging modalities. Fine needle aspiration (FNA) can help if coupled ...

A 74-year-old with a history of type 2 diabetes, chronic kidney disease, vitamin D deficiency and bronchiectasis was referred to the medical team with symptomatic hypercalcaemia with raised adjusted calcium of 3.80 mmol/l. Investigations also showed raised creatinine and vitamin D levels; normal parathyroid hormone (PTH) and angiotensin-converting enzyme (ACE). Myeloma screen was negative. A diagnosis of primary hyperparathyroidism was made in view of elevated calcium and norm...

A previously well 50-year-old female was admitted to the acute medical unit with a 4-month history of fatigue, anorexia, polyuria, polydipsia and arthralgia. She was found to be hypercalcaemic with a corrected calcium of 3.84 mmol/l and, unexpectedly, an extremely elevated parathyroid hormone reported at >200 pmol/l. Other results included an elevated alkaline phosphatase, hypophosphataemia and normal renal function. Treatment with intravenous 0.9% sodium chloride and pami...

We report a 61-year-old female with a history of bronchiectasis, primary Sjogren’s syndrome and osteoporosis. She had taken oral glucocorticoids initiated by the rheumatologists for 10 years, which were stopped 2 years ago. She was referred to the Endocrine Clinic with a short history of polyuria and polydipsia. Biochemistry confirmed new hypercalcaemia and an acute kidney injury: corrected calcium 3.14 mmol/l, phosphate 1.13 mmol/l and 25-hydroxyvitamin D 66.4 nmol/l. At...

Mr JP, a 64-year-old gentleman with a background of type 2 diabetes mellitius, ischaemic heart disease and hypertension was referred due to hypercalcaemia. He had a long history of hypercalcaemia, 9 years according to the biochemistry records and his adjusted calcium was 2.9 mmol/l on presentation. His parathyroid hormone level was 8.1 pmol/l. JP had clear symptoms of hypercalcaemia – polydipsia, polyuria, problems with concentration, fatigue, headaches and generalised ac...

Sixty six year old gentleman was referred to clinic with hypercalcaemia. He suffered with low mood, “funny turns”, nocturia and loose stools with urgency to open bowels. He appeared tanned but no increase pigmentation in skin folds. There was no palpable lymphadenopathy or neck lump. The calcium levels were around three with low normal PTH of 3.7 (2.8 on repeat). He had not developed any complications like osteoporosis, fracture or renal stones secondary to hypercalc...

We are presenting a common case of diagnostic dilemma with hypercalcemia.This 66 year female patient was referred to Endocrine clinic with hypercalcemia. She was asymptomatic with blood tests showing C.Calcium of 2.73 mmol/l. This was followed by investigations to rule out primary or tertiary hyperparathyroidism.Blood tests revealed high PTH of 12.2 pmol/l with low 25OH Vitamin D of 37 nmol/l, suggesting a diagnosis of tertiary hyp...

The calcium-sensing receptor (CaSR) is a G-protein coupled receptor expressed in the parathyroid gland and kidneys. Loss of function mutations of the CaSR result in familial hypocalciuric hypercalcaemia (FHH). Rarer, gain of function mutations of the CaSR result in hypercalciuric hypocalcaemia and are inherited in an autosomal dominant pattern. The phenotype varies from asymptomatic individuals, to profound hypocalcaemia. We present a severely affected individual whose case hi...

A 60-year-old Caucasian lady was referred to the metabolic bone clinic for assessment of osteoporosis. Her risk factors for osteoporosis included gender, postmenopausal status, childhood immobility due to illness, previous severe vitamin D deficiency, COPD, as well as an extensive smoking and alcohol history. She had multiple previous fragility fractures involving her ribs and both radii. A DEXA scan revealed lumbar osteoporosis (T -4.0) and femoral osteopenia (T -2.0). Thorac...