Endocrine Abstracts

Introducing: Primary hyperparathyroidism (HPT1) is a frequent endocrinopathy. Diagnosed incidentally or in front of a urinary or bone symptomatology, we report a case of primary hyperparathyroidism in the mode of revelation makes the originality “a paralyzing sciatica”.

Observation: The patient was 44 years old and was undergoing neurosurgery for chronic low back pain that was resistant to etiological treatment. In view of the persistent and hyperalgesic nature of the disease, a detailed radiological work-up was carried out: CT scan of the spine with multiple somatic lesions in the lumbosacral region and in the iliac wings. The diagnosis of multiple myeloma was ruled out and on the phosphocalcic workup: primary hyperparathyroidism was diagnosed (with parathyroid hormone (PTH) elevated to 1033 pg/ml, hypercalcemia at 116 mg/l compared to albuminemia at 36 g/l, high calciuria at 392 mg/24h, low phosphorus level at 12 g/l with total protein at 76 g/l);A cervico-thoraco-abdomino-pelvic CT scan showed a left parathyroid nodule measuring 3.6 cm with thyroid nodules classified as TIRADS 2, 3, and 4, the patient benefited from a total thyroidectomy with excision of the parathyroid nodule, on anatomopathological examination: aspect of a parathyroid adenoma subsequently substituted in calcium and vitamin D

Discussion: Primary hyperparathyroidism results from an increased secretion of parathyroid hormone (PTH), associated with hypercalcemia, most often related to a parathyroid adenoma, hyperplasia of the parathyroid glands and parathyroid carcinoma are very exceptional. The classic presentation associating fibrocystic osteitis, chondrocalcinosis, nephrocalcinosis, renal colic, and the digestive and neuropsychic clinical signs of hypercalcemia is less and less frequently encountered in Western countries, but remains frequent in some countries. The diagnosis of severity and the etiological diagnosis allow the indications and the modalities of surgical treatment to be determined; any symptomatic form (bone, kidney or hypercalcemia-related signs) constitutes an indication for surgery. Minimally invasive parathyroidectomy is the first-line treatment for most patients.

Conclusion: The presence of diffuse cervical and lower extremity polyarthralgia may not be due to osteoarthritis alone. This deserves a thorough investigation such as a blood calcium and PTH measurement