Endocrine Abstracts

Introduction: hyperparathyroidism is usually diagnosed at a pauci or asymptomatic stage. However, in rare cases, the diagnosis is made at the stage of major threatening hypercalcemia. This diagnostic delay may be responsible for complications such as chronic end stage renal disease (CRRD).

Observation: we report the case of a 64-year-old patient referred to the endocrinology department for primary hyperparathyroidism, with no particular family history and a personal history of type 2 diabetes mellitus known for 14 years, high blood pressure and renal lithiasis performed 14 years ago (without etiologic exploration). Hyperparathyroidism was discovered following a review commissioned by the nephrologist for the exploration of malignant hypercalcemia. The clinical examination revealed major signs of hypercalcemia and a large cervical nodule. Biology: PTH >560 pg/ml twice with serum calcium >130 mg/l, renal balance: clearance at 24 ml/min. This CKD has long been considered secondary to diabetic nephropathy while it was strongly in favor of interstitial nephropathy due to chronic hypercalcemia due to the absence of diabetic retinopathy. Cervical ultrasonography: 45 mm parathyroid macro-nodule. The patient received hyperhydration and injectable biphosphonates 30 times (Bondronate: the only one listed in the CRI) before referring him to surgery.

Discussionmalignant hypercalcemia is a sign of severity in primary hyperparathyroidism, hence the value of screening for asymptomatic forms to avoid life-threatening complications