Recurrent primary hyperparathyroidism

Faroug Ahmed

doi:10.1530/endoabs.91.CB67

Introduction: - Primary hyperparathyroidism is a relatively common disorder affecting 1 in 500 women and 1 in 2000 men aged over 40 years. - Diagnosis of primary hyperparathyroidism is confirmed biochemically with synchronous elevation of serum calcium and inappropriate elevation of parathyroid hormone. - Parathyroid adenomas are the most common aetiology. Around 80% are a single, benign adenoma, which in most cases is sporadic. Multiple adenomas and hypertrophy of all 4 glands are less common.

Case presentation: A 78-year-old male with previous history of Primary hyperparathyroidism in 2018, Basal cell carcinoma, CKD 3 and IHD. He was diagnosed with primary hyperthyroidism in 2018 after he had had high calcium during routine blood. Renal USS did not show no renal stones. Bone Mineral density revealed osteopenia. Parathyroid US, difficult to identify any parathyroid adenoma. Sestamibi scan: demonstrates intensely sestamibi avid prolapsed right superior parathyroid adenoma 2.3 cm inferior to the lower border of the cricoid cartilage. There is a further low grade sestamibi avid 2.9 cm prolapsed left superior adenoma 2.1 cm inferior to the lower border of the cricoid cartilage. For that he underwent parathyroidectomy and the two adenomas had been removed and confirmed to be parathyroid adenomas. After the surgery he had normal calcium Level till Jul 2022 when he was admitted to the hospital. He was not on any medications that can cause hypercalcemia. MM screening was negative. Vitamin D Level was normal. During the hospital admission he was managed with hydration, bisphosphonate and Cinacalcet. Given that he has hypercalcemia after normal level calcium more than 6 months after the surgery, the impression was recurrent primary hyperthyroidism. Further plan included parathyroid Ultrasound, Sestamibi scan, 24 hours urinary calcium excretion and discussion regarding possible parathyroidectomy. Unfortunately, the patient died before completion of the investigation with un-related issue.

In 2018
	Level	Refrence
Adjusted calcium	2.94 mmol/l	2.2-2.6 mmol/l
Phosphate	0.43 mmol/l	0.80-1.50 mmol/l
PTH	16.3 pmol/l	1.6-6.9 mmol/l
eGFR	45 ml/min

Discussion and Learning point: Recurrent primary hyperparathyroidism is defined as a recurrence of hypercalcaemia after a normocalcaemic interval of greater than 6 months post-parathyroidectomy. It is more common in patients with double parathyroid adenomas compared with those with a single adenoma or hyperplasia.

During admission:
	Level	Refrence
Adjusted calcium	3.02 mmol/l	2.2-2.6 mmol/l
Phosphate	0.74 mmol/l	0.80-1.50 mmol/l
PTH	17.3 pmol/l	1.6-6.9 mmol/l
eGFR	42 ml/min

Endocrine Abstracts

CB67