Endocrine Abstracts

Introduction: Celiac disease (CD) an autoimmune disorder of the small intestine, was considered as a disease of childhood. The symptoms can be obvious. That is the main reason why CD is underdiagnosed in elderly patients.Aims & Methods: The purpose of our study was to demonstrate a clinical case of CD which was diagnosed in a 41-year-old female patient. The patient attended our clinic with complains of weakness, tenderness, abdominal distension, weig...

Background: Papilledema and raised intracranial pressure has been reported frequently in patients with hypoparathyroidism but very rarely optic neuritis (1).Clinical case: We report a case of 63-year-old male who presented to ophthalmology with right-sided visual loss and a relative afferent pupillary defect. He was diagnosed with optic neuritis and underwent MRI brain which showed bilateral white matter changes with the possibility of demyelination. He ...

Introduction: Parathyroid carcinoma is a rare malignancy of the parathyroid glands. Parathyroid carcinoma may be suspected, but it usually cannot be confirmed prior to operation.Case: A 35-year-old male was consulted to Endocrinology department with persistant kidney stones. He was operated five times in 10 years for recurrent kidney stones.His lab results are as follows; Ca:13(8.8–10.6), P:2.2 mg/dl(2.5–4.5), ALP:84U/L(3...

Introduction: Atypical parathyroid adenoma (APA) is rarely encountered cause of primary hyperparathyroidism (PHPT). No definite criteria are considered to distinguish preoperatively APA from parathyroid typical adenoma or carcinoma.The aimTo describe the clinical course of a patient with an atypical parathyroid adenoma with severe hypercalcemia and multiple fragility fractures.Case presentation: A 61-year-old...

Congenital fibrous dysplasia is a rare disease with a broad spectrum of manifestations, including various endocrinopathies;precocious puberty, hyperthyroidism, excess growth hormone, hypophosphatemia mediated by FGF23.We present the case of a 33 year old male, who presented in our endocrinology service with infertility and bone pain. He was diagnosed at the age of years old with congenital fibrous dyplasia and suffered multiple surgeries for bone decompr...

Introduction: Parathyroid hyperplasia is the second cause of primary hyperparathyroidism (PH), representing 15–20% of all cases. The scintigraphy with Tc-99m-Sestamibi is a preoperative exam used to identify parathyroid adenomas or hyperplasia. It has a sensibility of 50–90%, which increases with larger parathyroid size. The neck ultrasonography (US) has also an important role detecting parathyroid enlarged glands with 70% sensibility. We report a case of parathyroid...

Objective: A young woman presented with marked hyperparathyroidism with post-operative course complicated by hungry bone syndrome and diagnostic and management challenges of ongoing hypocalcaemia with hyperparathyroidism.Method: ML, a 32-year-old Fijian Indian female, was referred with severe hypercalcaemia, following one-year history of migratory debilitating bone pain. Initial labs showed corrected calcium (C.Ca) 3.17 [2.10–2.60 mmol/l], parathyro...

Introduction: Familial hypocalciuric hypercalcemia (FHH) is an autosomal-dominant genetic disease caused by an inactivating mutation in the gene encoding the calcium sensing receptor (CaSR). The loss of function leads to increased circulating level of PTH and subsequent hypercalcemia.Case report: 20-year-old male patient referred to our center with hypercalcemia which was found after the syncope. His serum calcium level was 11.7 mg/dl and the phosphorus ...

Background: Hypercalcemia may stimulate thyroid’s C-cells to produce the calcitonin, that could lead to misdiagnosis of medullary thyroid cancer.Clinical case: A 47-year-old woman suffered from fracture of the left knee. She could not walk and used a wheelchair. CT scan in a public hospital detected multiple bone lytic changes in the ribs and vertebrae (mts?), tumor in the liver (mts?) and node in the thyroid gland 2.6*1.9 cm. Thyroid biopsy showed ...

The aim: To study the case of Pachydermoperiostosisis.Material and methods: We report a case of a 24-year old male complaining of marked changes in appearance due to the disfiguring thickening and wrinkling of skin, excessive greasiness and perspiration, marked horizontal creases on the forehead, with deep furrows between them, increase in the thickness of eye lids, “senile expression” of the face, thickening of distal parts of extremities, fin...

Dementia describes a set of symptoms such as memory loss, difficulties with thinking, problem solving or language. Vascular dementia is a second most common type of dementia, rare under 65 year old. I report a case of 57- year-old woman with diagnosed dementia vascularis in Neurology department. Beside neurological diagnostic methods(brain scan-CT, MRI, Color Doppler of carotids, she had hypercalcaemia (2.96–3.04 mmol/l; normal range 2.20–2.60) as high calciuresis/24...

66-year old woman came first for an evaluation of nodular thyroid disease. Primary hyperparathyroidism (PHPT) was incidentally diagnosed during the entrance lab test with total calcium 2.62 mmol/l and PTH 93 ng/l. Serum creatinine was normal and 25 OH vitamin D was 97 nmol/l. Dual-energy X-ray absorptiometry was carried out and revealed osteoporosis at lumbar spine. Moreover, there were two low-trauma fractures in a recent patient history. Although hypercalcemia was mild, the ...

Background: Primary hyperparathyroidism (PHPT) is one of the most common endocrine diseases. Parathyroid carcinoma, a rare entity, comprises a small percentage of patients with hyperparathyroidism and represents 0.005% of all cancers and <1% of cases of PHPT.Material and methods: Patients was diagnosed at the Endocrinology Department of Diskapi Yildirim Beyazit Training and Research Hospital between 2010 and 2016. Ultrasound and 99mTc-Sestamibi confi...

Parathyroid adenomas (85% of cases of primary hyperparathyroidism) are usually small in size (weigh 70 mg – 1 g). Giant parathyroid adenomas (GPTA) weighing more than 3.5 g are very rare, more common in males, in the 6th decade of life, generally affect one parathyroid gland, are oxyphilic and ectopic in 50% of cases.We report the case of a 53-year-old woman presented for asthenia, fatigue, tingling in the arms and legs without other symp...

Introduction: Autosomal dominant hypocalcemia (ADH) is a rare condition, caused by activating mutations in the calcium-sensing receptor (CASR) gene. Affected individuals have hypocalcemia with inappropriately low parathyroid hormone (PTH) levels.Case report: A 50-year-old woman, asymptomatic, was referred to our Endocrinology department for investigation of hypocalcemia detected in routine blood analysis (serum corrected calcium was 7.4 mg/dl &#...

The most frequent pathology of primary hyperparathyroidism presented with the findings of hypercalcemia is parathyroid adenoma. Some patients having the signs of primary hyperparathyroidism may have intrathyroidal parathyroid adenoma and it may be overlooked. We present a case of intrathyroidal parathyroid adenoma presented with bone pain.47-year-old female patient referred to our clinics with bone pain and she had no pruritus, dry mouth, dyspepsia, abdo...

Introduction: Parathyroid carcinoma (PC) is a rare endocrine malignancy which accounts for 0.005% of all cancers and less than 1% of primary hyperparathyroidism cases. This uncommon tumor usually occurs during the fifth decade of life, with equal frequency in both sexes, and has an indolent but progressive course. It’s frequently symptomatic and patients may have high values of serum calcium and parathyroid hormone (PTH) with a palpable cervical mass. PC generally occurs ...

Primary Hyperparathyroidism is a common endocrine disorder characterized with high parathyroid hormone (PTH) and calcium (Ca) levels. Although most of the patients are asymptomatic, some patients may be presented with renal, gastrointestinal, musculoskeletal, neurologic or cardiovascular signs associated with hypercalcemia or elevated parathyroid hormone related findings such as bone disease, nephrolithiasis, hypophosphatemia increased production of calcitriol, hypomagnesemia,...

A 60-year-old male patient who presented with left hip and knee pain was found to be compatible with primary hyperparathyroidism (PTH:2233 pg/ml, calcium: 15.7 mg/dl, phosphorus: 2.9 mg/dl creatinin:1.99 mg/dl, 25-OH-D:9.7 μg/l, ALP:532 mU/ml). Bone grafts of the patient showed multiple lytic lesions in the pelvis, cranium and long-bones. Neck ultrasonography showed hypoechoic solid nodule with cystic areas, 2×2 cm with size in the left thyroid gland inferior region ...

Case History: A 37 year-old gentlemen was referred to metabolic bone clinic due to recurrent recent fragility fractures. He had several fractures throughout childhood, and these had continued to occur into his adult life. He was blind in his left eye since birth. He felt that this had contributed to his fractures, due to falls. There had been no other previous major health problems. His brother had a similar eye condition. There were no other risk factors for osteoporosis. The...

Introduction: The otorhinolaryngologist can be confronted to multiple surprises after a thyroid surgeryCase description: We report the case of a 48 year-old woman admitted with post operative hypocalcaemia (after thyroidectomy?). The patient has a history of hypothyroidism since 5 years. She then presented a cervical swelling. The ultra-sound confirmed the presence of a suspicious thyroid nodule measuring 4 cm. A thyroidectomy was then conducted. Post op...

Background: Brown tumor of bone is a non-neoplastic lesion resulting from abnormal bone metabolism in hyperparathyroidism. Brown tumor, as the only and initial symptom of normocalcemic primary hyperparathyroidism is extremely rare.Case presentation: A 69-year-old female patient was admitted to the hospital with a mass in the right thigh. A mass lesion of the right distal femur with bone and soft tissue infiltration was observed in the lower extremity mag...

Introduction: Bisphosphonates, generally considered as safe drugs, are potent inhibitors of bone calcium outflow used to treat osteoporosis and hypercalcemia associated with malignancy. Bisphosphonate-induced hypocalcaemia is an increasingly reported complication, but it has not yet been a subject of comprehensive research.Case report: A 65-year-old woman had a history of Crohn’s disease and ankylosing spondylitis medicated with prednisolone and eta...

Introduction: Calcium ions (Ca2+) play an essential role in process of correct β-cell insulin secretion. Hypocalcemia impairs insulin secretion leading to glucose metabolism disorders and insulin resistance.Case study: 62 -year old female patient with 18 years history of type 2 diabetes, treated with insulin, suspected of hypoparathyroidism, was admitted to the Department and Clinic of Endocrinology, Medical University of Lublin because o...

Hyperparathyroidism jaw tumour syndrome (HPT-JT) is an autosomal dominant disease with variable penetrance. Onset is typically in late adolescence or early adulthood. Primary hyperparathyroidism is typically caused by a single parathyroid adenoma but parathyroid carcinoma occurs in 10–15%. Ossifying fibroma of the mandible or maxilla occurs in 30–40%, and may be locally aggressive. 15% of patients have renal manifestations which include polycystic kidney disease, Wil...

Introduction: Fahr syndrome is a rare entity characterized by the presence of bilateral intracranial calcifications with predilection for the basal ganglia and dentate nuclei. It is commonly associated with endocrine disorders, particularly parathyroid and Vitamin D disturbances. Herein we report a case of pseudohypoparathyroidism revealed by Fahr syndrome.Observation: A 29-old-year male was referred to our department for symptomatic hypocalcemia. He sho...

Introduction: The differential diagnosis of cystic cervical masses includes thyroid cyst, thymic cyst, thyroglossal duct cyst, branchial cleft cyst, bronchogenic cyst, lymphangioma and parathyroid cyst (PC). PC is one of the less common causes of the cervical masses.Methods: We report the case of a 37-year-old man admitted to the hospital with a neck mass of 48 mm.Results: Our patient presented with neck pain and an hipoechogenic n...

Introduction: Differential diagnosis between secondary hyperparathyroidism (SHPTH) and possible pseudohypoparathyroidism can be challenging in case of insufficient diagnostic tools and co-existing medical conditions. We report a diagnostic road to final diagnosis.Case report: A 48-years old white male-to-female transgender patient was admitted to our clinic for evaluation due to mental deterioration, general fatigue, slowly progressing bilateral upper ar...