Reviewing the Possible Rare Reasons for Normal Parathyroid Hormone, Vitamin D and Serum Calcium Levels in a Patient...

Literature evidence describing a seeming de novo occurrence of severe osteoporosis accompanied by the presence of parathyroid adenoma with normal serum parathormone level (PTH), normal serum vitamin D, and serum calcium levels is rare; hence, this case report. In the absence of raised parathormone levels and the demonstration of the presence of parathyroid adenoma, the hypothesis that the authors were left with was that could certain forms of parathyroid adenoma express factors or active substances with severe osteoclastic activity. Or, could certain expressed PTH molecules in parathyroid adenoma scenarios prove difficult to assay using conventional study methods? We have reviewed the literature in a bid to provide answers to these possible uncommon scenarios. We present the case of the above occurrence in a 65-year-old female patient with no genetic evidence of familial hypocalciuric hypercalcemia or familial hyperparathyroidism and with a normal renal function test.