Endocrine Abstracts

Introduction: Hyperparathyroidism happens when one or more of parathyroid glands secret excessive parathyroid hormone, causing calcium levels in blood to rise. A diagnosis may be missed or delayed because there are no symptoms or they are vague, like depression, tiredness, losing your appetite in addition to hypercalcaemia symptoms e.g. vomiting, bone and joint pain, dehydration, hypertension, etc. Surgery to remove the parathyroid gland is usually the only way of treating primary hyperparathyroidism. Patients who are unable to have surgery, cinacalcet tablet may help control the condition while being sure to have a healthy and balanced diet.

Method: A 57 years old female patient with 115 kg weight and 160 cm height and a history of osteoarthritis, osteoporosis, joint pain and inability of movement in addition to depression was referred to our endocrinology clinic. Since COVID-19 pandemic, she had to leave her job as a teacher and staying at home. This situation dramatically deteriorated her mental health and intensified weight gain procedure. Considering her history and laboratory examination results, especially high plasma level of calcium, hyperparathyroidism was diagnosed. Nevertheless, no medicine was prescribed for her. Analyzing her routine nutrition, we found that her daily liquid intake was very low ca. 2 glasses, accompanied by irregular meals with almost no snack. Instead, an intense diet of 1500 kcal per day with high citrate, magnesium and B-complex and low calcium and high liquid consumption was designed in order to change her nutrition style for 6 months. The diet was planned to balance her meals with 3 main meals and 3 snacks in the meantime. She was recommended to consume more citrus and lemons and no spinach to prevent renal calculi formation. Her health condition was monitored every week by our dietitian staff.

Results: After one month of this intense diet, the patient lost 5 kg of her weight. She reported a kind of lightheadedness feeling, amelioration of joint’s pain while she could walk 10 minutes at home each day. By 6 months follow up, she reported a remarkable improvement of her QOL and losing 12 kg of the weight, no more joint pains and no renal problem.

Conclusion: Although the effects of COVID-19 pandemic especially staying at home could worsen the symptoms of primary hyperparathyroidism and hypercalcaemia, a healthy and balanced diet seems to highly ameliorate these symptoms without the need of any medicine and prevent the surgery to remove the parathyroid gland.