A 73-year-old male patient with diabetes and hypertension who does not follow pharmacological treatment.
Two years earlier, she had been admitted with secondary hepatitis due to amoxicillin-clavulanic acid consumption.
Since then he was being followed up by a specialist in Gastroenterology.
In several controls, he had presented slightly elevated levels of plasma calcium, although the origin of this analytical alteration had not been determined.
He did not follow chronic treatments and did not report toxic habits.
She was admitted due to acute pancreatitis, epigastric pain, oral intolerance, and a significant increase in amylase and lipase levels, with the rest of analytical data being anodyne.
The evolution is favorable in the first days, with improvement of pain and reinstauration of the oral diet.
However, the patient suddenly suffered a worsening of his clinical condition, with new onset of abdominal pain and progressive deterioration of consciousness, with fluctuating episodes of disconnection of the medium, achieving a normal serum calcium level of 15.5 mg/dl.
Levels of intact parathyroid hormone (iPTH) were determined: 311.2 pg/ml (normal values < 9 pg/ml) and a cervical ultrasound was performed that reported a thyroid lobe mass with a cystic appearance.
The patient required admission to the Intensive Care Unit, with poor outcome in the following days.
Hypercalcemia could not be corrected despite medical treatment and iPTH reached 1,900 pg/ml.
Surgery was performed, removing a parathyroid nodule dependent on the left upper gland, after which iPTH decreased to 324.7 pg/ml, becoming normal in the following hours.
Ionized plasma calcium decreased equally, with values reaching the upper limit of normal.
However, despite the support measures, the patient could not overcome a refractory shock with intense lactic metabolic acidosis, dying from asystole unresponsive to resuscitation.
