A 57-year-old female patient in July 2013 was referred to our unit for the study of asymptomatic hypercalcemia.
In her personal history, the patient was diagnosed with type 2 diabetes mellitus (controlled with diet and oral antidiabetics), hypercholesterolemia, hypertension and morbid obesity (BMI=50.5 kg/m2).
The patient was receiving statins, metformin and an angiotensin converting enzyme inhibitor (ACE).
Clinically, he was asymptomatic, and hypercalcemia was detected by his primary care physician in the context of metabolic control for his previous pathologies.
The patient was treated conservatively for 48 years and did not receive hormonal replacement therapy.
He had not suffered fractures.
Upon confirming the existence of asymptomatic primary hyperparathyroidism PHTP due to the presence of elevated calcemia after correction with total proteins, elevated serum PTH, and other causes of hypercalcemia were ruled out with intraoperative videoproportion.
Table 1 shows the analytical data of the patient before and one year after surgery, together with the reference values in our hospital.
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Table 2 shows the densitometric data, including TBS, before and one year after surgery.
Densitometry was performed with a Hologic® Discovery 4500 densitometer, and the TBS was estimated using the program facilitated by TBS insights from Medimaps Group in this same densitometer.
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Table 3 shows the surgical indication criteria for asymptomatic primary hyperparathyroidism (PHPT) from 1990 to the latest update of 2013, along with the patient's clinical data.
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In Figure 1, the parathyroid MIBI-Tnecio99 scintigraphy shows the presence of a focus of high activity in the center-thoracic location and retroid situation in the mediastinum suggesting the existence of a parathyroid adenoma.
Figure 2 shows the evolution of both DXA and TBS in the lumbar spine one year after surgery.
