iatroX Rounds #13
The clues
- 1
A 62-year-old woman presents to her GP complaining of feeling increasingly tired, thirsty, and generally under the weather for several months.
- 2
She describes a change in her bowel habit towards persistent constipation and mentions vague, generalized abdominal discomfort.
- 3
Her medical records show two previous attendances for renal colic and a recent DEXA scan indicating reduced bone mineral density.
- 4
During the consultation, she notes that she is drinking significantly more water than usual and waking up three times a night to pass urine.
- 5
Initial investigations show a corrected calcium level of 2.82 mmol/L and a serum phosphate level of 0.65 mmol/L.
- 6
The clinical picture is explained by a hormone level that is found to be 12.2 pmol/L, which is inappropriately elevated rather than suppressed by the high calcium.
Primary hyperparathyroidism is a common endocrine disorder where one or more glands autonomously produce too much hormone, leading to high serum calcium. It is most frequently caused by a solitary benign adenoma and is a leading cause of hypercalcaemia in the non-hospitalized population.
- Hypercalcaemia with low or low-normal serum phosphate
- Inappropriately raised or normal parathyroid hormone levels
- Recurrent nephrolithiasis and reduced bone mineral density
- Symptoms of polyuria, polydipsia, constipation, and low mood
for education and entertainment. not medical advice.