Bilateral Staghorn Calculi and Urosepsis as Uncommon Presentations of Primary Hyperparathyroidism

Abstract

Background Primary hyperparathyroidism (PHPT) is a prevalent endocrine disorder characterized by excessive parathyroid hormone (PTH) secretion, traditionally associated with hypercalcemia and consequential skeletal and renal complications. While the typical manifestations of PHPT are well-documented, instances of its co-occurrence with bilateral staghorn calculi are infrequently reported. Case presentation: We present the case of a 64-year-old Hispanic female who presented with abdominal pain and sepsis. Subsequent investigations revealed bilateral staghorn calculi on abdominal computed tomography. Metabolic profiling demonstrated hypercalcemia (10.8 mmol/L), elevated intact PTH levels (132.3 pg/mL), normal phosphorus (2.6 mmol/L), and vitamin D levels (43.5 IU). Urinary cultures isolated extended spectrum beta-lactamase (ESBL) E. coli, and seven days of Ertapenem was administered. Suspecting PHPT, a parathyroid 14-sestamibi single photon emission computed tomography (SPECT) was performed, disclosing a 6 mm right inferior parathyroid mass indicative of a parathyroid adenoma. Initiation of Cinacalcet therapy resulted in a prompt decline in serum calcium levels within 48 hours. The patient was planned for surgical intervention involving parathyroidectomy and bilateral nephrolithotomy. Conclusions This case highlights the importance of comprehensive metabolic evaluation for patients presenting with bilateral staghorn calculi, emphasizes the need for a timely and tailored approach to urological and endocrinological management.