Primary hyperparathyroidism causing posterior reversible encephalopathy syndrome: a case report.

Area of Science:

• Neurology
• Endocrinology
• Radiology

Background:

• Posterior reversible encephalopathy syndrome (PRES) is a neurological condition characterized by vasogenic edema and neurological deficits.
• Primary hyperparathyroidism is a condition involving overactive parathyroid glands, leading to elevated parathyroid hormone (PTH) and calcium levels.
• PRES is typically associated with hypertension, immunosuppression, and renal failure, but can occur in other contexts.

Observation:

• A 64-year-old woman with symptomatic primary hyperparathyroidism (PTH 1,330 ng/L, calcium 4.83 mmol/L) presented with intractable seizures.
• Brain MRI revealed bilateral symmetrical T2 hyperintensities in the posterior circulation, indicative of PRES.
• A parathyroid adenoma was identified via Technetium-99m sestamibi scan.

Findings:

• The patient underwent parathyroidectomy, with preoperative and postoperative PTH levels of 1,021 ng/L and 10 ng/L, respectively.
• Neurological symptoms resolved, and the patient was extubated on postoperative day 1, making an uneventful recovery.
• All neurological symptoms resolved by the 6-week follow-up appointment.

Implications:

• This case underscores that PRES can manifest in patients with severe hyperparathyroidism, even without typical risk factors.
• Early recognition and management of hyperparathyroidism may be crucial in preventing or resolving PRES.
• The findings suggest that severe hypercalcemia secondary to hyperparathyroidism could be an underrecognized trigger for PRES.