Hypercalcemia as a manifestation of a mild form of hyperparathyroidism: a clinical case

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Abstract

Background. The practical interest in the mild form of primary hyperparathyroidism (PHPT) is attributable to the asymptomatic course of the disease and the difficulty of timely diagnosis due to the lack of a widespread study of the blood calcium level. In some cases, the detection of a normocalcemic variant of the mild form of PHPT can be considered as an early diagnosis of overt PHPT.

Description of the clinical case. The article considers a clinical case of diagnosis of normocalcemic variant of PHPT in a 42-year-old woman.

Conclusion. The initial stages of PHPT and mild forms are asymptomatic, patients rarely complain, which often leads to slowly progressive irreversible changes in a number of organs and systems: in the kidneys, causing the possible development of renal failure; in the gastrointestinal tract (GIT) with recurrent erosions and ulcers; in the bone skeleton with development of osteopenia and osteoporosis and, as a result, to a decrease in the quality of life and disability. The description of this clinical case demonstrates the importance of routine determination of calcium levels and vitamin D concentrations in the absence of complaints.

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About the authors

Inessa B. Zhurtova

Kabardino-Balkarian State University n.a. Kh.M. Berbekov, Faculty of Medicine

Author for correspondence.
Email: zhin07@mail.ru
ORCID iD: 0000-0003-0668-1073

Dr. Sci. (Med.), Professor at the Department of Faculty Therapy, Kabardino-Balkarian State University n.a. Kh.M. Berbekov, Nalchik, Russia

Russian Federation, Nalchik

Ir. B. Zhurtova

Primary Healthcare Unit of the Ministry of Internal Affairs of Russia for the KBR

Email: zhin07@mail.ru
ORCID iD: 0009-0001-0899-9379
Russian Federation, Nalchik

E. Z. Khachmakhova

Primary Healthcare Unit of the Ministry of Internal Affairs of Russia for the KBR

Email: zhin07@mail.ru
ORCID iD: 0009-0006-6537-3969
Russian Federation, Nalchik

M. A. Elgarova

Kabardino-Balkarian State University n.a. Kh.M. Berbekov, Faculty of Medicine

Email: zhin07@mail.ru
ORCID iD: 0000-0002-5390-1377
Russian Federation, Nalchik

References

  1. Фархутдинова Л.М. Первичный гиперпаратиреоз: современные представления и клиническое наблюдение. Архивъ внутренней медицины. 2020;10(2):94–101. [Farkhutdinova L.M. Primary hyperparathyroidism: current concepts and clinical observation. Arkhiv» vnutrennei meditsiny. 2020;10(2):94–101. (In Russ.)]. doi: 10.20514/2226-6704-2020-10-2-94-101.
  2. Макаров И.В., Галкин Р.А., Прокофьева Н.А. и др. Опыт диагностики и хирургического лечения первичного гиперпаратиреоза. Эндокринная хирургия. 2017;11(2):81–9. [Makarov I.V., Galkin R.A., Prokofieva N.A. Experience in the diagnosis and surgical treatment of primary hyperparathyroidism. Endokrinnaya khirurgiya. 2017;11(2):81–9. (In Russ.)]. doi: 10.14341/serg2017281-8.
  3. Российская ассоциация эндокринологов, Ассоциация эндокринных хирургов. Клинические рекомендации «Первичный гиперпаратиреоз». М., 2020. 110 с. Russian Association of Endocrinologists, Association of Endocrine Surgeons. Clinical guidelines «Primary Hyperparathyroidism». M., 2020. 110 p. (In Russ.)].
  4. Khan A.A., et al. Primary hyperparathyroidism: review and recommendations on evaluation, diagnosis, and management. A Canadian and international consensus. Osteoporos Int. 2017;28(1):1–19. doi: 10.1007/s00198-016-3716-2.
  5. Wermers R.A., et al. The rise and fall of primary hyperparathyroidism: a population-based study in Rochester, Minnesota, 1965–1992. Ann Int Med. 1997;126(6):433–40. doi: 10.7326/0003-4819-126-6-199703150-00003.
  6. Мокрышева Н.Г., Мирная С.С., Добрева Е.А. и др. Первичный гиперпаратиреоз в России по данным регистра. Проблемы эндокринологии. 2019;65(5):300–10. [Mokrysheva N.G., Mirnaya S.S., Dobreva E.A. et al. Primary hyperparathyroidism in Russia according to the registry. Problemy endokrinologii. 2019;65(5):300–10. (In Russ.)]. doi: 10.14341/probl10126.
  7. Мокрышева Н.Г. Первичный гиперпаратиреоз: современное представление о проблеме. Лечение и профилактика. 2013;2:143–52. [Mokrysheva N.G. Primary hyperparathyroidism: a modern view of the problem. Lechenie i profilaktika. 2013;2:143–52. (In Russ.)].
  8. Мокрышева Н.Г., Гуляева С.С., Рожинская Л.Я. и др. Тяжелое течение гиперпаратиреоза у пожилых. Клинические наблюдения. Проблемы эндокринологии. 2009;55(1):33–5. [Mokrysheva N.G., Gulyaeva S.S., Rozhinskaya L.Ya. et al. Severe course of hyperparathyroidism in the elderly. Clinical observations. Problemy endokrinologii. 2009;55(1):33–5. (In Russ.)].
  9. Castellano E., Tassone F., Attanasio R., et al. Mild primary hyperparathyroidism as defined in the Italian Society of Endocrinology’s Consensus Statement: prevalence and clinical features. J Endocrinol Invest. 2016;39(3):349–54. doi: 10.1007/s40618-015-0412-6.
  10. Bollerslev J., Marcocci C., Sosa M., et al. Current evidence for recommendation of surgery, medical treatment and vitamin D repletion in mild primary hyperparathyroidism. Eur J Endocrinol. 2011;165(6):851–64. doi: 10.1530/EJE-11-0589.
  11. Silverberg S.J., Bilezikian J.P. Evaluation and management of primary hyperparathyroidism. J Clin Endocrinol Metab. 1996;81(6):2036–40. doi: 10.1210/jcem.81.6.8964825.
  12. Allerheiligen D.A., Schoeber J., Houston R.E. et al. Hyperparathyroidism. Am Fam Physician. 1998;57(8):1795–802.
  13. AACE/AAES Task force on primary hyperparathyroidism. The American Association of Clinical Endocrinologists and the American Association of Endocrine Surgeons position statement on the diagnosis and management of primary hyperparathyroidism. Endocr Pract. 2005;11(1):49–54. doi: 10.4158/EP.11.1.49.
  14. Potts J.T., Ackerman I.P., Barker C.F., et al. Diagnosis and management of asymptomatic primary hyperparathyroidism. National Institutes of Health Consensus Development Conference. October 29–31, 1990. Consens Statement. 1990;8(7):1–18.
  15. Bilezikian J.P., Potts J.T., Fuleihan Gel-H., et al. Summary statement from a workshop on asymptomatic primary hyperparathyroidism: a perspective for the 21st Century. J Clin Endocrinol Metab. 2002;87(12):5353–61. doi: 10.1210/jc.2002-021370. Problems of Endocrinology. 2019. Article in Press. doi: 10.14341/probl10126.
  16. Eastell R., Arnold A., Brandi M.L., et al. Diagnosis of asymptomatic primary hyperparathyroidism: proceedings of the third international workshop. J Clin Endocrinol Metab. 2009;94(2):340–50. doi: 10.1210/jc.2008-1758.
  17. Bilezikian J.P., Brandi M.L., Eastell R., et al. Guidelines for the management of asymptomatic primary hyperparathyroidism: summary statement from the Fourth International Workshop. J Clin Endocrinol Metab. 2014;99(10):3561–69. doi: 10.1210/jc.2014-1413.
  18. Yeh M.W., Ituarte P.H., Zhou H.C., et al. Incidence and prevalence of primary hyperparathyroidism in a racially mixed population. J Clin Endocrinol Metab. 2013;98(3):1122–29. doi: 10.1210/jc.2012-4022.
  19. Yu N., Donnan P.T., Murphy M.J., Leese G.P. Epidemiology of primary hyperparathyroidism in Tayside, Scotland, UK. Clin Endocrinol (Oxf). 2009;71(4):485–93. doi: 10.1111/j.1365-2265.2008.03520.x.
  20. Мокрышева Н.Г. Первичный гиперпаратиреоз: эпидемиология, клиника, современные принципы диагностики и лечения. [Дисс. канд. мед. наук. М., 2011. 44 c. Mokrysheva N.G. Primary hyperparathyroidism: epidemiology, clinic, modern principles of diagnosis and treatment. Diss. Cand. of Med. Sciences. M., 2011. 44 p. (In Russ.)].
  21. Saliba W., Barnett O., Rennert H.S., et al. The Relationship Between Serum 25(OH)D and Parathyroid Hormone Levels. Am J Med. 2011;124(12):1165–70. doi: 10.1016/j.amjmed.2011.07.009.
  22. Heaney R.P. The vitamin D requirement in health and disease. J Steroid Biochem Mol. Biol. 2005;97:13–9. doi: 10.1016/j.jsbmb.2005.06.020.
  23. Holick M.F. Vitamin D deficiency. N Eng J Med. 2007;357:266–81. doi: 10.1056/NEJMra070553.
  24. Monchik J.M., Gorgun E. Normocalcemic hyperparathyroidism in patients with osteoporosis. Surgery. 2004;136(6):1242–46. doi: 10.1016/j.surg.2004.06.052.
  25. Lowe H., et al. Normocalcemic primary hyperparathyroidism: further characterization of a new clinical phenotype. J Clin Endocrinol Metab. 2007;92(8):3001–5. doi: 10.1210/jc.2006-2802.
  26. Silverberg S.J., Bilezikian J.P. “Incipient” primary hyperparathyroidism: a ”forme fruste” of an old disease. J Clin Endocrinol Metab. 2003;88(11):5348–52. doi: 10.1210/jc.2003-031014.
  27. Christensen S.E., et al. Discriminative power of three indices of renal calcium excretion for the distinction between familial hypocalciuric hypercalcaemia and primary hyperparathyroidism: a follow-up study on methods. Clin Endocrinol. 2008;69(5):713–20. doi: 10.1111/j.1365-2265.2008.03259.x.
  28. Nordenstrom E., Katzman P., Bergenfelz A. Biochemical diagnosis of primary hyperparathyroidism: analysis of the sensitivity of total and ionized calcium in combination with PTH. Clin Biochem. 2011;44(10–11):849–52. doi: 10.1016/j.clinbiochem.2011.04.002.
  29. Amin A.L., et al. Normal PTH levels in primary hyperparathyroidism: still the same disease? Ann Surg Oncol. 2011;18(12):3437–42. doi: 10.1245/s10434-011-1744-x.

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