Endocrine Abstracts

Introduction: Primary hyperparathyroidism is a condition in which one or more parathyroid glands have a pathological secretion of parathyroid hormone due to their abnormal function. Secondary hyperparathyroidism has normal parathyroid glands, but an abnormal secretion of PTH because of an underlying condition that influence their activity. It is important to differentiate between primary and secondary hyperparathyroidism because of the different treatment.

Methods: Review of the patient’s record and the relevant literature.

Case report: A 68 year old woman, with personal antecedents of non-Hodgkin’s lymphoma suffered a total en bloc gastrectomy with caudal splenopancreatectomy, left adrenalectomy and cholecystectomy; was admitted to the hospital with recently diagnosed hyperparathyroidism and hypocalcemia most probably due to malabsorption. The patient also associates type II diabetes, postmenopausal osteoporosis and renal failure stage IIIa. The patient complains of paresthesia in all four limbs. Physical examination revealed height of 165 cm, weight of 83 kg (gained 10 kg in the last year), BMI of 30.40 kg/m², excess of fat tissue with central disposition, moist and warm skin, blood pressure was 110/70 mmHg, heart rate was 65 beats/minute, normal thyroid dimensions. No signs of hypocalcemie were noticed. Blood tests showed elevated blood glucose, normal thyroid function, slightly low serum calcium (Ca=7.6 mg/dl, normal value 8.4-10.2 mg/dl), elevated parathyroid hormone (PTH= 1158 pg/ml, normal value <65 pg/ml) and a deficit of 25-OH vitamin D (25-OH vit D= 8.1 ng/ml, normal value 20-100 ng/ml). The complete blood count, hepatic and renal tests results were normal. A computer tomograph was performed and it revealed no tumoral rest or recurrence near the eso-jejunal anastomosis.

Results: Considering all of the above, we concluded that the pacient had secondary hyperparathyroidism due to malabsorption after total en bloc gastrectomy. We initiated supplementation oral treatment with vitamin D spray 4000UI/day and calcium 40 mg/day. The evolution was favorable, with a decrease of PTH value from 1158 pg/ml to 153.2 pg/ml and vitamin D from 8.1 ng/ml to 22.8 ng/ml after 1 year of treatment.

Conclusions: This case report highlights the importance of determining the etiology of the hyperparathyroidism. This is because the treatment for primary hyperparathyroidism in most cases is surgical (parathyroidectomy), while in the case of a secondary parathyroidism, the treatment consists mostly of supplementation with calcium and vitamin D.