Primary hyperparathyroidism in asymptomatic older adults in Honduras: case report

Abstract

Introduction: Primary hyperparathyroidism (PHPT) is characterized by hypercalcemia, hypophosphatemia and elevated levels of parathyroid hormone (PTH). Profile of an older woman 50 years old, , and is detected in her asymptomatic presentation by measuring serum levels of calcium and phosphorus. 85% of cases are asymptomatic and are due to a PTH-producing parathyroid adenoma. The symptomatic case may have kidney damage, osteoporosis and cardiovascular involvement. Imaging studies are performed to look for adenomas; management can be surgical or conservative. Case description: 77-year-old female, with arterial hypertension, asymptomatic. He went for routine evaluation with vitamin D 10.6 ng/ml, serum creatinine 1.7 mg/dl, serum calcium 11.9 mg/dl, albumin 4.5 g/dl, phosphorus 2.26 mg/dl, PTH 163.30 pg/ml, neck ultrasound without masses, normal abdominal ultrasound and normal electrocardiogram. Conservative management with bisphosphonate was decided. Second case: 75-year-old female, with arterial hypertension, asymptomatic. He came with routine examinations with calcium 12 mg/ dl, phosphorus 2.36 mg/dl, vitamin D 17.1 ng/ml, PTH 340 pg/ mL, electrocardiogram with sinus bradycardia, normal abdominal ultrasound, and thyroid ultrasound with a 1.4 cm nodule. 1.6 cm. Conservative management with bisphosphonate was decided. Conclusion: Screening should be performed in female over 60 years of age, measuring serum calcium and phosphorus levels; if these are altered, PTH is measured. In asymptomatic older adults, conservative management can be performed and in symptomatic patients, treatment is surgical.