An uncommon case of persistent hypercalcaemia following parathyroid surgery

Authors:Indrajit Talapatra, Ian Patrick Michael O Connel
Int J Biol Med Res. 2015; 6(4): 5336-5340  |  PDF File

Abstract

A 67 year old woman was referred by her GP for raised serum calcium and raised Parathyroid hormone (PTH) to the clinic in June 2011. The patient had high calcium with raised PTH for six years, since 2005, prior to been seen in the clinic. The patientís renal function was normal and was diagnosed with Primary Hyperparathyroidism. Urinary calcium over 24 hours was mildly elevated and there was no evidence of kidneys stones on imaging. However a DEXA scan showed evidence of osteoporosis. The patientís Vitamin D level was normal and she was referred to a tertiary hospital for Parathyroidectomy. However the patientís serum calcium and PTH levels continued to remain high despite Parathyroid surgery. Subsequently for failed Parathyroidectomy the patient underwent a CT scan of thorax which suggested the presence of an ectopic mediastinal Parathyroid adenoma. The patient was not thought to be suitable for thoracic surgery and hence kept under monitoring for her serum calcium. The patientís recent Vitamin D level was found to be low and was commenced on Vitamin D supplementation. The calcium level became quite high and Vitamin D supplementation had to be withheld briefly. The decision was taken to treat the patient later with low dose Vitamin D simultaneously with Cinacalcet