Endocrine Abstracts

78 years old lady admitted with fall and right hip fracture under the orthopaedic team was referred to endocrinology with high calcium levels (2.84 mmol/l). Patient was mobile and independent, had a mechanical fall, no preceding symptoms. She had no symptoms of hypercalcemia. She had background history of osteoarthritis and previous history of removal of skin cancer. She was taking calcium supplements, but they were stopped at the time of admission. She was an ex-smoker. Her mother had a hip fracture but there was no family history of hypercalcemia. Her clinical examination didn’t reveal any neck swelling, no breast lump, or any lymphadenopathy or organomegaly. Her hypercalcemia work up showed PTH of 22.37 pmol/l, normal renal function, myeloma screen was normal, full blood count was normal, and CRP was raised post operatively. Initially she was treated with intravenous fluids, and she received bisphosphonates. Further work up showed normal chest X-ray and no evidence of malignancy on chest, abdomen, and pelvis CT scan. She was discharged from the hospital after her blood calcium levels were below 2.80 mmol/l(2.2-2.6mmol/l) and she started to mobilize. Further tests were done as an outpatient. DEXA scan showed BMD Lumbar spine, T Score: -3.6 BMD Total Hip, T Score: -3.5 BMD Femoral Neck, T Score: -3.7 Her calcium levels started to creep up, so she was started on cinacalcet in Outpatient clinic. Her Urine calcium creatinine clearance ratio was 0.0175, Vitamin D levels were 49.2 nmol/l. Urinary 24 calcium was 10.14 mmol/24h (2.5-7.5), TFTS, ACE levels and anti-TTG were within normal range. Ultrasound neck showed a 11 x 6 x 15 mm isoechoic nodule with polar vascularity in right thyroid lobe inferiorly, likely a parathyroid lesion. SPECT CT scan of parathyroid showed 8x13x15 mm SPECT avid right nodule. She was discussed in parathyroid MDT and the outcome was to offer urgently right inferior targeted parathyroidectomy.