A 59-year-old man with a history of hypertension treated with valsartan 80 mg/day and recurrent urolithiasis (last episode 2003).
Established by hypercalcemia for study, she only referred bipsychia.
Physical examination revealed 81 kg, 180 cm, PAml 140 mmHg and low thyroid with a palpable left cervical nodule of 4 cm. The study revealed calcemia 14.9 mg/dL, PTH 844 pg/65 pg/ml.
Cervical ultrasound showed a 40 mm lower left nodule displacing the thyroid toward the midline, heterogeneous, firm consistency and highly vascularized. Abdominal ultrasound revealed bilateral renal lithiasis with dominant image of 9 mm to the right.
A parathyroid scintigraphy MIBI-Spect showed increased uptake in the left lower parathyroid.
Double radiological bone densitometry (Lunar Prodigy, T score) showed L2-L4 -1.3, right femoral neck -2.0, and distal radius -3.5.
The review of her previous tests showed hypercalcemia for at least 4 years.
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With a diagnosis of long-standing primary hyperparathyroidism with bone and renal involvement, she was hospitalized for hydration and administration of 4 mg IV zoledronate as preparation for surgical resolution.
After 24 h, having decreased calcemia to 11 mg/dL, left thyroid lobectomy was performed, which included adhered parathyroid nodule.
The biopsy was reported as parathyroid adenoma of 28 mm and 22.6 g, adhered to the thyroid lobe, well-defined, with complete thin capsule, without signs of malignant neoplasia in the sections examined and without lymph node involvement.
The PTH curve suggested healing, with a fall > 90% (preoperative PTH 916 pg/ml and 15 min post-excision 88.2 pg/ml)3.
On the 3rd postoperative day, the patient was asymptomatic with calcemia 9.8 mg/dL; anemia 1.96.6 mg/dL; PTH 1 pg/ml, and was discharged.
However, 7 days after surgery calcemia 8.8 mg/dL; anemia 2.1 mg/dL; AF 166 U/L; albuminemia 3.9 g/dL, PTH 230 pg/mL and 25 ng/mL were observed.
A total of 50,000 IU per week (x6 times per week) was administered, and calcium carbonate/vitamin D 500 mg/800 IU (calcium sulfate/ 69.5 ng/day) was administered to patients undergoing surgery (27.5 ng/day).
Patient reported improvement of mental illness and intellectual performance during evolution.
