A 79-year-old male patient, married, micro-entrepreneur, with a university education level, treated with escitalopram 10 mg daily for a depressive syndrome.
She presented with a five-month history of anxiety, general muscle aches that were greater in the neck region, the main one being a progressive loss of memory, which was also confirmed by her family members.
Physical examination was normal.
Brain CT was requested and showed signs of brain volume loss, described as age-related.
Laboratory study including complete blood count, ESR, renal and hepatic function and thyroid hormones was normal, except hypercalcemia (10.7 mg/dl), with phosphorus 2.5 mg/dl and albumin of 4.3 pg/dl.
She was hospitalized for study. Parathyroid scintigraphy with planar MIBI and SPECT showed a hyperfunctioning left lower parathyroid gland (left hip T score of 243.5 hours) and a right hip T score of 243.5 hours.
Bone cystogram showed a slight increase in uptake in the posterior aspect of l5-S1 and in the right patella, compatible with degenerative changes.
No evidence of secondary bone involvement.
During hospitalization, comprehensive psychiatric assessment was performed, which was independent in basic and instrumental activities of daily living.
The patient was awake, spatially oriented, attentive, able to watch series (days of the week) without difficulty.
Placement of Mini Mental Test (MMSE) 20/30, with memory failures, series subtraction and drawing copy.
Ability of compatible impairment preserved functional thinking, with coherent language and organized thinking. list of animals: 6 in 1 minute and clock test not achieved (patient cognitive impairment with executive orientation) with cognitive impairment criteria and spatial organization.
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It was decided in an interdisciplinary way and together with patient and family to perform left inferior parathyroidectomy, evolving without complications and discharged on the third day after surgery. the biopsy showed a parathyroid adenoma of 1.3 gofophilic.
One month after discharge, tests were controlled: calcemia of 9.5 mg/dl, phosphorus of 3 mg/dl, PTH 45.5 pg/ml (normal), albumin of 4.2 g/dl, and the patient reported improvement without muscle pain.
Two months later, the patient was monitored in a geriatric polyclinic, performing cognitive assessment.
The MMSE was 26/30 (previous to 20), failing only in series subtraction. Animal list increased to 9 in one minute. achieved the clock test, executive organization 3 (P and minor errors).
