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Case Reports in Endocrinology
Volume 2016, Article ID 3016201, 4 pages
http://dx.doi.org/10.1155/2016/3016201
Case Report

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

1Endocrinology Department, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, IMSS, 06720 Mexico City, DF, Mexico
2Faculty of Medicine, Universidad Nacional Autónoma de México (UNAM), 04510 Mexico City, DF, Mexico
3Division of Medicine, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, IMSS, 06720 Mexico City, DF, Mexico

Received 28 March 2016; Accepted 23 June 2016

Academic Editor: Michael P. Kane

Copyright © 2016 Victoria Mendoza-Zubieta et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Persistent primary hyperparathyroidism (PHPT) refers to the sustained hypercalcemia state detected within the first six months following parathyroidectomy. When it coexists with severe vitamin D deficiency, the effects on bone can be devastating. We report the case of a 56-year-old woman who was sent to this center because of persistent hyperparathyroidism. Her disease had over 3 years of evolution with nephrolithiasis and hip fracture. Parathyroidectomy was performed in her local unit; however, she continued with hypercalcemia, bone pain, and pathological fractures. On admission, the patient was bedridden with multiple deformations by fractures in thoracic and pelvic members. Blood pressure was 100/80, heart rate was 86 per minute, and body mass index was 19 kg/m2. Calcium was 14 mg/dL, parathormone 1648 pg/mL, phosphorus 2.3 mg/dL, creatinine 2.4 mg/dL, urea 59 mg/dL, alkaline phosphatase 1580 U/L, and vitamin D 4 ng/mL. She received parenteral treatment of hypercalcemia and replenishment of vitamin D. The second surgical exploration was radioguided by gamma probe. A retroesophageal adenoma of 4 cm was resected. Conclusion. Persistent hyperparathyroidism with severe vitamin D deficiency can cause catastrophic skeletal bone softening and fractures.