Endocrine Abstracts

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 aches and pains. Due to his high calcium level and PTH level he was diagnosed with primary hyperparathyroidism and due to the calcium level and his symptoms he was sent for localisation studies as work up for potential surgery. Sestamibi and ultrasound scans of his neck unfortunately did not reveal a clear site of a parathyroid adenoma, however after discussion with the surgeon, JP decided to proceed with a parathyroid exploration with a view to removing an adenoma. In the meantime, he was referred for an MRI scan of his neck and mediastinum before the procedure. MRI was unhelpful and he went for surgery and had three of four parathyroid glands removed (leaving the left upper behind) without and surgical complications. PTH and calcium levels fell after the surgery but not back into the reference ranges. JP was feeling better after the surgery although he still had some residual symptoms. The plan at this stage was to review again in 6 months and if the biochemistry remained deranged then to re-image with a view to removing the final gland. When see again in clinic in 6 months (9 months after surgery) JP was feeling lethargic and had headaches however the thirst and aches and pains had remained resolved. His adjusted calcium level was 2.96 mmol/l however his parathyroid hormone level was normal at 5.0 pmol/l. A 24-h urine collection for creatinine/calcium ratio was arranged in order to exclude concurrent familial hypocalcuric hypercalcaemia. He was advised to drink less tea (was drinking 20 cups/day) due to possible diuretic effect raising his calcium. The urine collection was normal. At the time of writing he is awaiting a repeat calcium level.