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

Area of Science:

• Endocrinology
• Skeletal Biology
• Surgical Case Reports

Background:

• Persistent primary hyperparathyroidism (PHPT) is defined as sustained hypercalcemia post-parathyroidectomy.
• Coexistence with severe vitamin D deficiency exacerbates skeletal complications.
• PHPT can lead to significant morbidity including nephrolithiasis and fractures.

Purpose of the Study:

• To report a case of persistent primary hyperparathyroidism with severe vitamin D deficiency.
• To illustrate the devastating skeletal consequences of this combined condition.
• To discuss the management and outcome of such a case.

Main Methods:

• Case report of a 56-year-old woman with persistent hyperparathyroidism and severe vitamin D deficiency.
• Initial management included parenteral hypercalcemia treatment and vitamin D replenishment.
• Second surgical exploration utilized radioguided localization for adenoma resection.

Main Results:

• The patient presented with severe hypercalcemia (14 mg/dL), elevated parathormone (1648 pg/mL), and profound vitamin D deficiency (4 ng/mL).
• She experienced multiple pathological fractures and was bedridden prior to the second surgery.
• Resection of a 4 cm retroesophageal adenoma was performed successfully.

Conclusions:

• Persistent primary hyperparathyroidism and severe vitamin D deficiency can result in catastrophic bone softening and fractures.
• Prompt diagnosis and management, including surgical intervention, are crucial for improving outcomes.
• This case underscores the importance of addressing both conditions concurrently.