Endocrine Abstracts

Introduction: Primary hyperparathyroidism (PHPT) is a rare disorder among young adults. Classic manifestations of PHPT, such as nephrocalcinosis, nephrolithiasis, are rarely seen today.

Case report: We refer the case of a young male, 25 years old, presented in emergency unit with: headaches, lumbago, epigastric pain, weight loss (5 kg during six last months), polydipsia-polyuria. Medical history: He has been diagnosed with nephrolithiasis and gastritis a year ago. Negative family history. Blood biochemistry: Ca²⁺ level 2 mmol/l (N1.13–1.32 mmol/l), total calcemia 17.6 mg/dl (N 8.5–10), Phosphorus 2 mg/dl, Mg²⁺1.5 mg/dl, Hct 35,3%, Hgb11.3 g/dl, WBC: 5900/mm³, urea: 69 mg/dl, creatinine 1.6 mg/dl, sodium 144 mmol/l, potassium 3.7 mmmol/l, glucose 83 mg/dl, ALT 11U/l, AST 14U/l, GGT15U/l, LDH 140 U/l, Bilirubin Total 0.4 mg/dl, Chol 118, Tg 98, ferritinemia 89 mg/dl,TSH 1.49 ui/ml, Protein total 6.8 mg/dl. HGA resulted normal. Kidney ultrasonography: kidneys with calcifications of the pyramids, decreased cortico-medullary differentiation. Fundus oculi normal. Firstly we thought for chronic renal disease third stage in a subject with nephrocalcinosis. We performed PTH 745 ng/l (N15-65), 25 OH Vitamin D3 (16.3 ng/dl). We suspected a parathyroid gland disease, so we performed, Thyroid ultasonography: Right thyroid lobe normal, Left thyroid lobe with a well-restricted heterogeneous nodus, with internal cystic degenerations of 19×23 mm in the lower medial part. Isthmus normal. Thyroid shintiscan: with a hypofixant zone at the lower part of left thyroid lobe. Parathyroid scintigraphy resulted with parathyroid adenoma located at lower part of left thyroid lobe. Bone densitometry(DXA) showed in the forearm bones, high-risk osteoporosis with Tscore-5.4,osteopenia in femoral head and L4 lumbar vertebrae expressed osteoporosis,genetic testing was not done. He was treated with fluids i/v, diuretics, antihypertensives drugs. After diagnostic work-up,we concluded to PHPTcaused by parathyroid adenoma and the patient underwent surgical intervention with left hemithyroidectomy and left lower parathyroidectomy. Pathological examination: atypical parathyroid adenoma. After surgery he was treated with calcium orally and he was follow-up with PTH level, calcium level and DXA.We think that his problem was resolved by surgery. He continues to be stable, under nephrologist and endocrinologist follow up.

Conclusion: PHPT is a rare situation in a young person. A nephrocalcinosis can be related to PHPT. Given the low frequency of atypical parathyroid adenoma,especially in young individuals, physician should always raise awareness of possible PHPT as cause of nephrocalcinosis and kidney injury, for early diagnosis and treatment. Nephrocalcinosis may be the presenting feature of atypical parathyroid adenoma,our case confirmes that.