SURGERY FOR PRIMARY HYPERPARATHYROIDISM DIAGNOSED AS ACUTE RENAL FAILURE
Primary hyperparathyroidism (HPTH) is a common endocrine disorder characterized by multiple organic events secondary to hypercalcemia, including renal insufficiency. We introduce a case of primary HPTH diagnosed after presentation for recent-onset of renal insufficiency. A 60-year old male with no prior medical history was initially diagnosed with renal failure in the context of progressive malaise, nausea, recent onset of moderate blood pressure. Beside low glomerular filtration rate (eGFR of 15 mL/mim/1.73m2), biochemical evaluation showed hypercalcemia of 14.4 mg/dL (normal: 8.8-10.6 mg/dL), ionic calcium of 7.27 mg/dL (normal: 4.4-5.4 mg/dL), hypercalciuria of 343 mg/24h, normal:<300 mg/24h. Examinations performed for secondary causes of hypercalcemia have revealed increased value of parathyroid hormone (PTH) of 881.2 pg/mL (normal: 12-88 pg/mL). Thyroid ultrasound and cervico-mediastinal computed tomography highlighted an inhomogeneous hypoechoic lesion on the posterior side of the left lobe, with intra-thoracic extension, measuring 3.54/4.94/5.4cm with left parathyroid adenoma significance. The hormonal profile excluded multiple endocrine neoplasia syndrome (MEN). After improvement of biochemical parameters by adequate hydration and diuretic treatment, left parathyroidectomy was performed. One month later, normal PTH, calcium total, ionic calcium, and improvement of renal function have been achieved. Long-term follow-up by a multidisciplinary team was recommended.