Endocrine Abstracts

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). Thoracolumbar X-rays revealed vertebral loss of height at L3. On examination her BMI was 22.8 kg/m². Systemic examination was unremarkable with no endocrine cause for her osteoporosis revealed.

Following the clinic appointment, routine blood tests showed adjusted calcium 4.39 mmol/l (2.2–2.6), phosphate 1.00 mmol/l (0.8–1.5), PTH 59.7 pmol/l (1.1–6.8), vitamin D 27.7 nmol/l (70–150), creatinine 85 umol/l, and alkaline phosphatase 120 IU/l (30–130). Serum protein electrophoresis and thyroid function were normal.

Although she was asymptomatic, she was admitted for further investigations and management. ECG revealed a prolonged PR but normal QT interval. She commenced intravenous rehydration and also required pamidronate and cinacalcet to control her calcium levels. Neck ultrasound revealed a probable left superior parathyroid adenoma measuring 11×7×9 mm and she was referred for an urgent neck exploration and parathyroidectomy. A CT thorax, abdomen and pelvis showed a chronic ill-defined 18 mm right hilar mass. There were concerns that this could represent a granulomatous disease, and a trial of prednisolone was commenced pending biopsy. Histology showed just reactive tissue and steroids were then stopped. A few weeks following her admission, she underwent a left inferior parathyroidectomy with remaining glands reviewed as normal. There was no soft tissue invasion or lymphadenopathy. Histology showed hypercellular parathyroid tissue with no definite features of malignancy.

Post-surgery, adjusted calcium was 2.39 mmol/l and PTH 6 pmol/l and she awaits a further DEXA scan to assess for improvement in her severe osteoporosis.