The importance of determining the PTH level in the early phase of the assessment in elderly patients to exclude the early phase of hyperparathyroidism

Ana Davitashvili; Revazi Jamburia; Medea Zhgenti; Shota Janjgava; Aleksandre Mkhargrdzeli

doi:10.1530/endoabs.92.PS1-03-06

PS1-03-06

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Endocrine Abstracts (2023) 92 PS1-03-06 | DOI: 10.1530/endoabs.92.PS1-03-06

ETA2023 Poster Presentations Miscellaneous 1 (9 abstracts)

The importance of determining the PTH level in the early phase of the assessment in elderly patients to exclude the early phase of hyperparathyroidism

Ana Davitashvili ¹ , Revazi Jamburia ² , Medea Zhgenti ² , Shota Janjgava ³ & Aleksandre Mkhargrdzeli ⁴

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¹National Institute of Endocrinology, Endocrinology, Tbilisi, Georgia; ²National Institute of Endocrinology, 13 Lubliana Street, Endocrinology, Tbilisi, Georgia; ³Tbilisi State University, 13 Lubliana Street, Endocrinology, Tbilisi, Georgia; ⁴Tbilisi State Medical University

The Case Study: We report the case of a 68-year-old female referred to the E.R. department with severe neurological problems. Patient’s neurological status revealed that patient was disoriented in time and place, with emotional irritability and an asymmetric eye fissure, and not feeling well without any obvious reason. A preliminary CT scan with I/V contrast was done and acute neurological damage was excluded. In the lab, there were: hypokalemia, hypomagnesemia, increased CRP, Ca was within upper normal limits, kidney and liver function tests, CBC and urine tests, and coagulation factors were normal. On the second day, the patient’s condition gradually worsened. ABG was done: Ca- 2.62 mmol/l, Potassium 3.35 mmol/l. Developed fever, acute respiratory failure, arrhythmia, tachypnea and desaturation despite oxygen inhalation. She was transferred to the ICU and intubated. Cordarone 5-7 mg/kg/hr, as a part of an effective and safe drug, and Rivaroxaban were used to achieve sinus rhythm. And for febrile temperatures, antipyretic treatment was administered. On the third day, the MRI scan and lab tests were done. An MRI scan with I/V contrast showed lacunal ischemia (chronic) in the basal nuclei and large hemispheres bilaterally. After a thorough assessment, a neck mass was detected. With further assessment, it was identified as being of parathyroid origin. That scan showed a slightly asymmetric thyroid gland with nonhomogenous structure. On its right edge, dorsally, an oval-shaped, intensely contrasted nodule with a size of 1.0 x 0.6 cm was seen. Physicians ordered lab tests. Ca was elevated at 2.82 mmol/l, vit D3 was 17.10 ng/ml, ast 165.8, ALT -70.4, GGT-59.0, creatinine was 184 mkmol/l, and PTH was set out and it was 1799 pg/ml. Due to the patient’s severe condition, additional tests like scintigraphy was not done.

Conclusion: Our study showed that in elderly patients with neurological disturbances and upper normal limits or high calcium level should be determined PTH level on early phase of the assessment to exclude latent phase of hyperparathyroidism.