Endocrine Abstracts

Introduction: Sclerochoroidal calcification is an uncommon condition that classically manifests as multiple discrete yellow placoid lesions, often discovered as an incidental finding. It is ordinarily believed to be idiopathic, but is also associated with primary hyperparathyroidism. It is important that these patients are identified because of the systemic implications and treatable nature of these disorders.

Case: 82 years old patient with history of Primary Hyperparathyroidism and Osteoporosis was referred by the optometrist to the ophthalmology department after noticing raised pale lesions in his both fundi on a routine eye test. The patient was asymptomatic. The appearance is classical of Scleralchorodial Calcification related to hypercalcaemia caused by primary hyperparathyroidism. His corrected calcium was 2.83 mmol/l (2.20–2.60), Parathyroid hormone was 13.9 pmol/l (1.1–6.9), and PO4 was 0.66 mmol/l (0.8–1.5), Vitamin D was normal at 77.3 nmol/l (50–175), Creatinine 78 umol/l (60–105), EGFR 83 units (90–120).His urinary calcium creatinine ratio was 0.2. His ultrasound B-scan of both eyes show multiple hyper echoic deposits in the posterior ocular coats, persisting at low gain, and causing significant shadowing, consistent with calcium deposits.The lesions appear to be posterior to the muscle insertions.

Conclusion: Collaboration between different specialties (in this case between Endocrinology and Ophthalmology) is required in managing patients. Identifying these lesions promptly helps with the management of underlying systematic disorders involving abnormal calcium – phosphorus metabolism or renal tubular hypokalemic metabolic alkalosis syndromes. As an Endocrinologist, it is important to look for such associations and undertake thorough clinical examination, including fundoscopy, followed by prompt Ophthalmology referral. Our patient was already under Endocrine clinic follow up for conservative treatment of Primary Hyperparathyroidism. Despite several cases of Sclerochoroidal calcification reported in the literature it remains poorly recognized and can be misdiagnosed as a malignant tumor resulting in unwarranted intervention.