Primary Hyperparathyroidism overlapping with Multiple Sclerosis: a catastrophic marriage.

Area of Science:

• Endocrinology
• Neurology
• Geriatrics

Background:

• Primary hyperparathyroidism (PHPT) is a common endocrine disorder.
• PHPT can present with diverse neurological and psychiatric symptoms, often leading to misdiagnosis.
• Co-occurrence of PHPT and pre-existing neurological conditions like Multiple Sclerosis (MS) can complicate diagnosis.

Purpose of the Study:

• To report a unique case of severe PHPT mimicking a worsening of pre-existing Multiple Sclerosis (MS).
• To emphasize the importance of considering metabolic disorders in patients with unexplained neurological or psychiatric deterioration.
• To highlight the successful surgical management of PHPT and its impact on patient recovery.

Main Methods:

• Case report of a 77-year-old male presenting with fatigue, falls, nausea, anorexia, and constipation.
• Diagnostic workup included laboratory tests for calcium, phosphorus, and parathyroid hormone (PTH) levels.
• Neck Computed Tomography (CT) identified a parathyroid mass; surgical removal confirmed parathyroid adenoma.

Main Results:

• The patient presented with severe hypercalcemia (16.8 mg/dL) and elevated PTH (508 pg/mL), indicative of PHPT.
• Surgical removal of the parathyroid adenoma led to complete resolution of symptoms and normalization of calcium-phosphate metabolism.
• Improvement in diabetes control was also noted post-surgery, allowing a reduction in metformin dosage.

Conclusions:

• This case represents the first documented instance of significant symptom overlap between mild, long-standing MS and unrecognized severe PHPT.
• Thorough metabolic evaluation is crucial for patients experiencing worsening neuromuscular or neuropsychiatric symptoms, regardless of prior diagnoses.
• Prompt diagnosis and treatment of PHPT can lead to significant clinical improvement and prevent misattribution of symptoms to other conditions.