Endocrine Abstracts

Background: Primary hyperparathyroidism is more prevalent in women and sometimes the patients are without clinical signs. Parathyroid disorders aren’t uncommon in the general population.

Clinical case: A woman 68-year-old was present to the ambulatory visit with multiple joint pains and generalized weakness, constipation and weigh loss since 1 year ago. She hadn’t any history of fever, anorexia, nausea, vomiting or diarrhea. She refered that since 6 months she was taken a supplementation by her selves of Vitamin D (10 000 units of cholecalciferol) every day. No history of any chronic disease.

Lab results: We found a high values of 25(OH) Vitamin D 140 ng/ml, PTH 490 pg/ml and calcium values 16.6 mg/dl (8.5–10.1 mg/dl). The other results: Creatinine 0.8 mg/dl, GFR 58 ml/min, alkaline phosphatase 179 IU/l (46–119), urinary calcium 446 mg/24 h (42–353). Thyroid ultrasound: A solid cystic nodule in the right lobe of thyroid with dimensions 2.1×1.4×2.2 cm, without imaging evidence of a typical parathyroid adenoma. Parathyroid sestamibi scan: right parathyroid adenoma She was treated with intravenous (IV) saline and furosemide. The vitamin D3 was stopped and the patient underwent surgery, excision of the parathyroid adenoma. Pathological report confirmed diagnosis: parathyroid adenoma. The PTH values return to normal range after surgery and the calcium value was 10.2 mg/dl. In the following days calcium values were below normal range. Actually the patient was in treatment with calcium supplement and bisphosfonate for the treatment of osteoporosis. She was advice to have regulary follow up and to know sign of severe hypocalcemia.

Conclusions: Our case has a unknown primary hyperparathyroidism which was complicated with severe hypercalcemia as a result of over-supplementation with very high doses of vitamin D in a patient with unknown primary hyperparathyroidism.

Keywords: Primary hyperparathyroidism, hypercalcemia, vitamin D toxicity