Endocrine Abstracts

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 hyperparathyroidism. Patient was started on Vitamin D replacement. Repeat blood tests after 6 months showed normal C.Calcium of 2.46 mmol/l, normal 25OH Vitamin D level of 85 nmol/l but persisting high levels of PTH at 11.5 pmol/l.

At this stage we planned to repeat bone profile in 3 months. Next set of bloods revealed normal Calcium, 25OH Vitamin D of 95 nmol/l and PTH of 10.5 pmol/l.

Differentials of Primary Hyperparathyroidism vs Familial hypocalciuric hypercalcemia (FHH) were considered. Urine Calcium/Creatinine ratio was low 0.14 mol/mol suggesting FHH. This was followed by repeat urine calcium/creatinine ratio and 24 h urine calcium, both tests came back as normal, confirming primary hyperparathyroidism. Patient remained asymptomatic and eucalcemic, hence further investigations were deferred.

This was a good learning case with a common presentation in Endocrine clinics.