Endocrine Abstracts

Introduction: Proximal myopathy presents as symmetrical weakness of proximal upper and/or lower limbs. There is a broad range of underlying causes including drugs, alcohol, endocrine and metabolic myopathies such as primary hyperparathyroidism.

Observation: We describe a 48-year-old male, hospitalised in neurology departement for exploration of severe proximal myopathy. Cliniquely, he presented progressive debilitating muscle weakness, severe muscle wasting and recurrent muscle spasms over 6 months. He also had bone pain, anorexia and weight loss. He had a symmetrical proximal myopathy and muscle wasting marked in upper limbs. Biological explorations found a hight level of calcium 3.12 mmol/, hypophosphoremia 0.71 mmol/l, PTH 175 pg/ml, hight 24-hour urine calcium 851 mg/j, wich is suggestive of primary hyperparathyroidism. The creatine kinase (CK) levels was elevated of 637 U/l (30-200). Parathyroid ultrasound and SESTAMIBI scintigraphy localised a hyperfunctioning right inferior parathyroid adenoma of 16 mm. The levels of PTH inside the adenoma was 4070 pg/ml. Bone mineral density indicate an osteopenia (low bone density). He underwent successful parathyroidectomy following treatment with hyperhydration and intravenous pamidronate . There was resolution of muscular spasms, weight gain and normalisation of his calcium, PTH and and CK levels. The histopathological examination confirmed the parathyroid adenoma.

Conclusion: Severe proximal myopathy is a rare complication of primary hyperparathyroidism. Prompt diagnosis and parathyroidectomy can prevent complications and improve clinical outcomes.