Endocrine Abstracts

Introduction: Hyperparathyroidism is a condition marked by an overproduction of parathyroid hormone (PTH) due to excessive activity in one or more parathyroid glands. It is a prevalent disorder that may manifest as primary, secondary, or tertiary. In this report, we present three clinical cases highlighting intricate scenarios where determining the primary or tertiary origin of hyperparathyroidism proves challenging.

Case reports: A 33-year-old female with end-stage renal failure was diagnosed with hyperparathyroidism during her medical follow-up. Symptoms were associated with severe headaches and bilateral vision loss. An MRI revealed a pathological mass compressing the optic chiasm. Laboratory evaluation showed an elevated prolactin level, leading to the diagnosis of both hyperparathyroidism and prolactinoma. A 60-year-old female, under treatment for renal insufficiency due to multiple kidney stones, developed hypercalcemia with hyperparathyroidism. A MIBI scintigraphy revealed hyperactive uptake in a parathyroid gland in the left basal lower region. Parathyroidectomy was performed, revealing hyperplasia of the parathyroid gland. However, despite the intervention, persistent hyperparathyroidism was observed. A subsequent MIBIscintigraphy revealed an enlarged parathyroid gland on the right side. Parathyroidectomy was performed Patient, 63, with a 20-year history of nephropathy and end-stage renal failure, presented with progressive BAV, diplopia, hypoacusis, bone pain, and renal colic. Brain MRI showed a locally infiltrating lesion in the sphenoethmoidal complex. Nasal biopsy suggested a reparative granuloma. Cervical ultrasound revealed a multinodular goiter and a left parathyroid nodule. Hyperparathyroidism was confirmed. The patient underwent a left parathyroidectomy.

Discussion and conclusion: These three clinical cases present diagnostic and therapeutic challenges due to uncertainty regarding the primary or tertiary origin of hyperparathyroidism. In first case, the concurrent presence of a prolactinoma complicates the situation, making it difficult to determine whether the association between the prolactinoma and hyperparathyroidism is coincidental or part of multiple endocrine neoplasia type 1(MEN1). This uncertainty is further heightened by the inability to confirm the primary origin of hyperparathyroidism. Insecond case, despite the identification and surgical removal of a hyperplastic parathyroid gland, persistent hyperparathyroidism is observed, raising questions about possible primary or tertiary hyperparathyroidism related to parathyroid hyperplasia. In the third case, the diagnosis of hyperparathyroidism was established after the appearance of brown tumors in the context of chronic nephropathy with multi-lithiasic kidneys, complicating the clinical situation and highlighting the difficulty in distinguishing between primary and tertiary hyperparathyroidism. A multidisciplinary approach involving endocrinologists, nephrologists, and surgeons is essential for a comprehensive evaluation and optimal management of these patients.