case_images: PMC7318811_01
case_images: Time course of patient's serum parathyroid hormone and ionized calcium levels throughout the course of primary hyperparathyroidism management. PTx, parathyroidectomy.
case_images: 10.1177_2324709620936836-fig1.jpg
case_images: PMC7318811_01_10.1177_2324709620936836-fig1.jpg
case_images: fig1-2324709620936836
case_images: His initial laboratory values were as follows: PTH 205.6 pg/mL (14-72), serum albumin corrected calcium 10.9 mg/dL (8.5-10.2), ionized calcium 1.48 mmol/L (1.15-1.32), serum phosphate 2.5 mg/dL (2.5-4.5), urinary calcium 427.5 mg/24 h (30-400), and serum creatinine 0.9 mg/dL (0.7-1.4, estimated glomerular filtration rate [eGFR] 89 mL/min/1.73 m2; Figure 1). During further follow-up in October 2016, his serum calcium and ionized calcium returned to levels similar to before cinacalcet was initiated and most recent complaints, so his dose was increased back to 30 mg daily (Figure 1). Laboratory values showed hypoparathyroid hypocalcemia: PTH 6.9 pg/mL, serum albumin corrected calcium 7.2 mg/dL, and ionized calcium 0.96 mmol/L (Figure 1); serum magnesium was normal at 2.0 mg/dL. At that time, his PTH was within normal limits at 32.8 pg/mL, while serum albumin-corrected calcium and ionized calcium remained low (Figure 1). Within 6 months from starting the calcium supplements, his calcium levels improved and PTH level was within normal limits (Figure 1). There he was found to still have high-normal urinary calcium; hence, his supplemental calcium was further reduced and then discontinued resulting in normalization of urinary calcium excretion (Table 1) without altering eucalcemic state (Figure 1).