Endocrine Abstracts

A 47-year-old female was referred and presented with generalised aches and pains and her calcium level was found to be elevated with a corresponding raised PTH level. She had previously had a parathyroid hormone level in excess of 212.000 pmol/l(The upper limit for our assay is 212 pmol/l). Interestingly, she has had a mildly elevated calcium level in 2017, rechecked in 2018 and lost to follow up until December 2021. At this juncture, she sustained a closed fracture of her metacarpal which prompted further assessment due to the nature of the report from the Xray which suggested significant osteopenia and bone resorption. Other blood tests also showed persistent hypercalcemia, severe deficiency in Vitamin D and a high ALP in the range 2300-2400. Once admitted, due to her on going bone pain, she had multiple X-rays including that of her lumbar spine, pelvis and right knee. The common finding reported evidence of bony resorption particularly to the femoral necks bilaterally and several lucencies were noted within the femoral shafts bilaterally in keeping with brown tumours. Fortunately, no fractures were demonstrated. Additionally, a CT thorax, abdomen and pelvis was requested to rule out a malignancy and this, too, confirmed innumerable lytic lesions seen throughout the entire skeleton with no vertebral collapse and further sub-periosteal resorption noted at the sacroiliac joints and pubic symphysis. These lytic lesions were thought to represent multiple brown tumours on the background of hyperparathyroidism. Furthermore, her ultrasound neck revealed a small vascular mass in the lower pole of the left thyroid lobe suspicious for parathyroid gland hyperplasia. The subsequent Tc-99 MIBI nuclear medicine scan suggested there is a solitary focus of intense tracer activity present in the lower right position at the level just immediately above the right sternoclavicular joint. Appearances are entirely consistent with an autonomous solitary parathyroid adenoma. She has had an ENT review for consideration of surgical intervention which is currently awaited. We have therefore concluded that she has Primary hyperparathyroidism caused by likely a single adenoma. She has had surgical treatment of the lesion and is now starting to recover with close monitoring from the team in the hospital.