ATYPICAL PRIMARY HYPERPARATHYROIDISM DUE TO HYPOVITAMINOSIS D

Area of Science:

• Endocrinology
• Metabolic Bone Disease

Background:

• Vitamin D deficiency is prevalent in the general population and patients with primary hyperparathyroidism.
• Hypovitaminosis D can alter the clinical presentation and severity of primary hyperparathyroidism.

Observation:

• A 75-year-old woman with a decade of nephrolithiasis and severe osteoporosis presented with multiple fragility fractures.
• Despite subtle changes in serum calcium and phosphate, parathyroid hormone (PTH) levels were significantly elevated.
• Diagnostic imaging confirmed a left parathyroid adenoma.

Findings:

• The patient exhibited vitamin D deficiency (hypovitaminosis).
• Vitamin D deficiency can mask hypercalcemia in the presence of elevated PTH.
• Hypovitaminosis D appears to exacerbate, not reduce, the risk of kidney lithiasis and bone damage in primary hyperparathyroidism.

Implications:

• Recognizing vitamin D status is crucial for managing primary hyperparathyroidism.
• Aggressive management of vitamin D deficiency may be necessary to mitigate complications.
• This case highlights the complex interplay between vitamin D, PTH, and metabolic bone disease.