Endocrine Abstracts

Introduction: This case report explores the intricate relationship between polycythemia and hyperparathyroidism in a 42-year-old male, shedding light on the resolution of polycythemia following surgical intervention for PTH-dependent hypercalcemia. Despite the absence of symptomatic nephrolithiasis or renal failure, the patient’s DXA scan revealed osteoporosis, prompting a deeper investigation into the complex interplay between these two conditions.

Methods: Comprehensive diagnostics, including ultrasound and SPECT scans, identified a 3.4 cm parathyroid adenoma. Initial pharmacological interventions with Colecalciferol and Cinacalcet escalated, revealing a Cinacalcet dosage of 60 mg BD. Notably, the patient remained asymptomatic, presenting an intriguing clinical paradox.

Results: The excision of the right inferior parathyroid adenoma yielded more than a resolution of hypercalcemia. Postoperatively, the patient experienced a marked normalization of blood calcium levels and the unexpected resolution of polycythemia. Histological examination confirmed a solid cystic parathyroid adenoma with no malignancy, emphasizing the unique relationship between these two conditions.

Discussion: This case challenges existing paradigms, raising whether polycythemia may be an underrecognized consequence of hyperparathyroidism. Literature suggests an association between polycythemia and parathyroid carcinoma; however, the absence of malignancy, in this case, prompts consideration of broader factors influencing the resolution of polycythemia.

Follow-up and Management: Subsequent clinic assessments three months postoperatively revealed successful recovery and resolution of pins and needles. Cinacalcet was discontinued due to the normalization of blood calcium and PTH levels. The unexpected resolution of polycythemia underscores the importance of continuous monitoring and further research into the incidence and mechanisms of this phenomenon.

Conclusion: This case highlights the successful management of PTH-dependent hypercalcemia and emphasizes the need for heightened awareness of the potential relationship between hyperparathyroidism and polycythemia. Further studies are warranted to elucidate the intricate connections between these conditions and their impact on patient outcomes.