Determining primary from secondary hyperparathyroidism: A review of current management

Abstract

International Journal of Case Reports and Images (IJCRI) is an international, peer reviewed, monthly, open access, online journal, publishing high-quality, articles in all areas of basic medical sciences and clinical specialties.Aim of IJCRI is to encourage the publication of new information by providing a platform for reporting of unique, unusual and rare cases which enhance understanding of disease process, its diagnosis, management and clinico-pathologic correlations.IJCRI publishes Review Articles, Case Series, Case Reports, Case in Images, Clinical Images and Letters to Editor. Website: www.ijcasereportsandimages.comDetermining primary from secondary hyperparathyroidism: A review of current managementMichael Smith, Sherwin Schrag ABSTRACT Introduction: Primary hyperparathyroidism is the third most common endocrine disorder and the most common cause of hypercalcemia. Since the advent of automated serum chemistry machines, it is more common for hypercalcemia to be discovered incidentally. Secondary hyperparathyroidism is seen in the setting of chronic renal insufficiency. Both result in elevated parathyroid levels and in a patient with underlying renal disease distinguishing the primary from the secondary disease may be difficult. Case Report: A 60-year-old female presented to an emergency department with the complaints of constipation, weakness, dizziness that began acutely. She began to receive routine renal replacement therapy one month prior to presentation. A serum calcium level of 15 mg/dl was found on routine blood work. Further workup revealed a parathyroid hormone level of over 1000 pg/mL. Ultrasonography of the neck and sestamibi scan confirmed the location of the suspected lesion. On removal of the mass, which histologic examination revealed to be a 6.2 grams parathyroid adenoma, her calcium level returned to normal. Conclusion: Primary hyperparathyroidism requires surgical intervention for definitive therapy. Secondary hyperparathyroidism requires optimization of medical therapies to treat effectively in lieu of renal transplantation. In patients with underlying renal insufficiency and elevated calcium levels, imaging should be used to rule out parathyroid adenomatous disease and parathyroid carcinoma.