Persistent Primary Hyperparathyroidism, Severe Vitamin D Deficiency, and Multiple Pathological Fractures

الملخص EN

Persistent primary hyperparathyroidism (PHPT) refers to the sustained hypercalcemia state detected within the first six months following parathyroidectomy.

When it coexists with severe vitamin D deficiency, the effects on bone can be devastating.

We report the case of a 56-year-old woman who was sent to this center because of persistent hyperparathyroidism.

Her disease had over 3 years of evolution with nephrolithiasis and hip fracture.

Parathyroidectomy was performed in her local unit; however, she continued with hypercalcemia, bone pain, and pathological fractures.

On admission, the patient was bedridden with multiple deformations by fractures in thoracic and pelvic members.

Blood pressure was 100/80, heart rate was 86 per minute, and body mass index was 19 kg/m2.

Calcium was 14 mg/dL, parathormone 1648 pg/mL, phosphorus 2.3 mg/dL, creatinine 2.4 mg/dL, urea 59 mg/dL, alkaline phosphatase 1580 U/L, and vitamin D 4 ng/mL.

She received parenteral treatment of hypercalcemia and replenishment of vitamin D.

The second surgical exploration was radioguided by gamma probe.

A retroesophageal adenoma of 4 cm was resected.

Conclusion.

Persistent hyperparathyroidism with severe vitamin D deficiency can cause catastrophic skeletal bone softening and fractures.