Endocrine Abstracts

A 57-year-old gentleman presented with severe hypercalcaemia (Corrected Calcium 3.48 mmol/l) associated with polyuria and polydipsia. He denied pruritus, nausea, vomiting, abdominal pain, constipation or other aches and pains. He denied syncope, seizures, haematuria or recent urinary tract infections. He had a past history of bilateral urolithiasis as well as right pyelonephritis and hydronephrosis requiring nephrostomy, Crohn’s Disease and Diverticular Disease. Drug History included Mesalazine 1g 8-hourly, Azathioprine 150 mg daily, Omeprazole 20 mg daily, Vitamin B12 and Folic Acid. The above results are in-keeping with severe hypercalcaemia secondary to primary hyperparathyroidism (PHPT). A parathyroid adenoma could not be identified on ultrasound or 99mTc-sestamibi scan, however a possible right parathyroid adenoma was found on CT. Bone Density and Ultrasound Kidneys were normal. The patient was initially managed as an in-patient, in view of the severity of the hypercalcaemia. This included intravenous fluids and 4 mg Zoledronic acid IV, following dental review, as well as cardiac monitoring. However, the hypercalcaemia was refractory to the latter, and the patient was therefore started on Cinacalcet 30 mg 12-hourly and up-titrated to reduce the risk associated with severe hypercalcaemia pending parathyroidectomy. Two months after the acute presentation, the patient underwent an explorative parathyroidectomy with the right superior and inferior parathyroid glands excised. The former contained a parathyroid adenoma as identified on histology. PTH pre-incision was 92.5 pg/ml and 20 minutes post-excision 19.7pg/ml with an 80% delta change. Following parathyroidectomy, both parathyroid hormone and serum corrected calcium normalised, and the patient remained asymptomatic. Cinacalcet had been stopped one week prior to the parathyroidectomy.