| | Case # | Clinical description |
| | Case 1 | An 86-year-old woman with a history of osteopenia, hyperlipidemia, and GERD was diagnosed with PHPT with a calcium level of 13 mg/dl, iPTH level of 66 pg/ml, 25OHD 34 ng/ml and creatinine 1.07 mg/dl. She underwent surgery and had successful removal of a right upper parathyroid gland. She achieved surgical cure with normalized calcium and iPTH levels. Her last calcium was 9.7 mg/dl, iPTH 12.4 pg/ml and 25OHD 54 ng/ml at her 2 year follow up visit. | | Case 2 | A 91-year-old woman with a history of hyperparathyroidism with parathyroidectomy of 3.5 glands 5 years ago, hypothyroidism, osteoporosis, and goiter presented with a calcium level of 11.6 and iPTH level of 500. She was diagnosed with relapse of PHPT, and was managed with cinacalcet, furosemide, and risendronate. Serum calcium was controlled for about 8 years, but creatinine started to rise. Ten years after the recurrence of PHPT, cinacalcet had to be lowered and her bisphosphonate had to be discontinued after a further increase in creatinine. She suffered a left hip fracture and a possible aspiration event during the subsequent hospitalization. She passed away from sepsis after 10 years’ medical treatment of recurrence of PHPT. | | Case 3 | An 85-year-old woman with a history of a resected follicular Hurthle cell neoplasm presented with a calcium level of 11.5 mg/dl and iPTH of 279 pg/ml. She was diagnosed with PHPT and treated with cessation of hydrochlorothiazide, initiation of furosemide, and cinacalcet for 5 years. Cinacalcet dosage had to be increased after a year, but then subsequently discontinued due to worsening renal function (Cr 2.98–3.3 mg/dl). Five years after diagnosis her PTH level increased (483–511 pg/ml) but calcium was 10–11 mg/dL. She was hospitalized for cellulitis 6 years later and was discharged to hospice care for end-stage renal disease. She passed away at the age of 91. | | Case 4 | A 91-year-old man with a history of type 2 diabetes, hyperlipidemia, dementia, atrial fibrillation, and congestive heart failure was hospitalized for sepsis. He was found to have a calcium level of 11.1 mg/dl, iPTH 59 pg/ml, 24-hour calcium 203 mg, and 25OHD 26 ng/ml. He was diagnosed with PHPT. He was treated with calcitonin, oral hydration and furosemide. He was discharged to his long-term care facility. His calcium level remained normal up to 10.9 mg/dL with Cr 1.8 mg/dl at 1-year follow up. | | Case 5 | A 96-year-old woman with a history vitamin D deficiency, osteoporosis, and hypothyroidism was found to have a calcium level of 11.2 mg/dl, iPTH 165 pg/ml, and 24-hour urine calcium of 204 mg. A parathyroid scan showed a possible left lower pole adenoma. She refused surgery and was treated with zoledronic acid infusion for her osteoporosis. Calcium decreased to 10.2 mg/dL three years after diagnosis she was given a second zoledronic acid infusion. She was followed for 4 years and did well with serum calcium maintained from 10.2 to 10.7 md/dL and iPTH 147 pg/ml. | | Case 6 | An 86-year-old woman with a history of osteoporosis, hypertension and dementia was found to have a calcium level of 11.1 mg/dl, iPTH 100 pg/ml, and 25OHD 32 ng/mL. She did not tolerate bisphosphonate therapy and was treated with oral hydration, cessation of thiazide diuretic, and encouragement of physically activity. Two years after diagnosis, calcium levels were maintained in the high-normal range (10.2–10.5 mg/dl). Her dementia worsened and she suffered a left hip fracture 8 years after diagnosis. She passed away on hospice from a gangrenous wound after 8 years of expectant medical management of PHPT at age of 96. | | Case 7 | An 86-year-old woman with osteopenia treated with bisphosphonates and a selective estrogen receptor modulator, hypothyroidism, vitamin D deficiency and DVT was found to have a calcium level of 11.8 mg/dl, iPTH 128 pg/ml, 24-hour urine 142 mg, and 25OHD 31 ng/mL Sestamibi scan did not locate an adenoma. Expectant management with increased oral hydration, decreased milk intake, cessation of thiazides, and encouragement to increase activity was begun. Her calcium rose as high as 12.9 mg/dL but then settled to 11.2 mg/dL on subsequent measurement. She was followed without incident for 3 years. | | Case 8 | An 89-year-old woman with a history of hypothyroidism was found with a calcium level of 11.5 mg/dl, iPTH 95 pg/ml and 25OHD 24.6 ng/mL. She was asymptomatic and was managed expectantly with oral hydration and increased physical activity. Calcium was maintained from 10.2to 10.9 mg/dL and PTH 77–107 pg/ml. She was hospitalized for hypertensive urgency but otherwise had no sequelae for 6 years. |
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