Stones, bones, groans, thrones, and psychiatric overtones: Systemic associations of sclerochoroidal calcification

Abstract

Sclerochoroidal calcification (SCC) is a frequent masquerader of choroidal melanoma with important systemic associations such as hyperparathyroidism and parathyroid adenoma. Herein, we describe a case of a 67-year-old male who presented with an amelanotic choroidal lesion in the right eye (OD) and a history of kidney stones. Ultrasonography showed the lesion to be flat and calcified OD. Incidentally, a subclinical calcified plaque was also found in the fellow eye. Optical coherence tomography showed an elevated suprachoroidal mass in a table mountain configuration OD and flat configuration left eye, consistent with type 4 and type 1 SCC. The patient was referred for metabolic testing to rule out the underlying electrolyte imbalance and was found to be normal.

Diagnosis and Management Strategies in Sclerochoroidal Calcification: A Systematic Review

“…PTH is responsible for providing an equilibrium of serum calcium/phosphorus levels and when there is an imbalance due to excessive hormone production, serum calcium level increases resulting in metastatic calcification. 46 Secondary hyperparathyroidism which is usually caused by chronic kidney disease occurs secondary to elevated serum calcium levels and compensatory increased PTH production. 6 The second most common https://doi.org/10.2147/OPTH.S399058…”

“…The relationship between these syndromes and SCC is not yet fully understood. 20,46 Hypomagnesemia is also another important systemic association. Magnesium is known to have a role in the solubility of calcium pyrophosphate in the serum.…”

“…This mechanism is responsible for the tissue changes seen in calcium pyrophosphate deposition disease (pseudogout). 6,14,46 Besides, hypervitaminosis D causes hypercalcemia and results in calcification in sclera and choroid. Interestingly, one SCC patient in the literature was diagnosed with hypovitaminosis D. The authors did not bring an explanation to the coexistence of hypovitaminosis D and SCC.…”

Factors related to a non‐localising technetium 99m sestamibi scan result during parathyroid adenoma imaging in primary hyperparathyroidism

“…Hypercalcaemia can affect multiple organ systems leading to a variety of presentations, including pain (bone, muscle and abdominal or renal colic), psychiatric or cognitive impairment (depression, confusion and insomnia), polydipsia, polyuria, constipation, loss of appetite, nausea and vomiting 1,6 . However, a significant proportion of patients remain asymptomatic and are only identified incidentally through abnormal biochemistry.…”

“…5 Hypercalcaemia can affect multiple organ systems leading to a variety of presentations, including pain (bone, muscle and abdominal or renal colic), psychiatric or cognitive impairment (depression, confusion and insomnia), polydipsia, polyuria, constipation, loss of appetite, nausea and vomiting. 1,6 However, a significant proportion of patients remain asymptomatic and are only identified incidentally through abnormal biochemistry. The National Institute of Health (NIH) guidelines recommend parathyroid surgery in asymptomatic PHPT patients who meet the following criteria; age < 50 years, serum calcium > 0.25 mMol/L above normal range, creatinine…”