![]() Amlodipine and insulin were also added for worsening hypertension and diabetes. ![]() The patient was then transferred to our Endocrine Unit and treated with cinacalcet, with decrease of PTH, calcemia and calciuria values. Daily high-dose unfractionated heparin was also administered. The patient was treated with isotonic saline hydration, furosemide, supplementation of vitamin D and an injection of zoledronate 4 mg, with a mild improvement of hypercalcemia and related symptoms. Doppler ultrasound (US) revealed a deep vein thrombosis of the left posterior tibial vein. A CT pulmonary angiography detected partial thrombosis in three segmental branches of the right upper lobe pulmonary artery. A cranial computed tomography (CT) scan excluded acute cerebrovascular events. The electrocardiogram did not show remarkable signs of hypercalcemia. ![]() Blood count, liver and thyroid function were normal (Table 1). Biochemical assays revealed hypernatremia (149 mmol/L), severe hypercalcemia (4.08 mmol/L), hypophosfatemia (0.62 mmol/L), elevated levels of PTH (252 ng/L), reduced vitamin D (32 nmol/L) and slight renal failure (urea 8.7 mmol/L, creatinine 112 μmol/L). He did complain of dyspnea, dry skin and mucosa and muscle weakness, without bone pain and neurological alterations. On physical examination he was sleepy, apyretic, hypertensive (upright blood pressure 150/100 mmHg) and tachycardic (100 beats for minute). He had a personal history of hypertension and type 2 diabetes, treated with losartan and metformin respectively. The early diagnosis and treatment of this condition improved final outcome.Īn 80-year old man was admitted to a general hospital for polyuria, vomiting, weight loss, worsening asthenia, myalgia and progressive cognitive impairment. The post-operative period was also characterized by a symptomatic transient thyrotoxicosis, probably induced by previous exposure to iodine load and/or thyroid surgical manipulation. In this paper we report a complex case of an elderly patient with symptomatic PHPT associated with a functional transient hypercortisolism, resolved only after parathyroid surgery. In older patients, concomitant morbidity and poly-pharmacotherapy may worsen symptoms and complications, and impact the management of PHPT. In some cases a renal colic is the first presentation of the disease. However, many patients may suffer from minimal symptoms such as asthenia, constipation, polyuria, hypertension and neuro-psychiatric complications. The most common presentation of PHPT is an asymptomatic hypercalcemia, incidentally found on routine blood tests. Less than 10% of cases are inheritable, often associated with multi-gland hyperplasia. PHPT mainly is a sporadic disorder, caused in 85% of the cases by a single adenoma, in 15% by multi-gland disease and rarely by parathyroid carcinoma. Primary hyperparathyroidism (PHPT) is the third most common endocrinopathy seen today, frequently found in the 6 th to 7 th decade of life. Due to the increase in prevalence and the evidence of many related complications even in asymptomatic PHPT, expert opinion-based guidelines for surgical treatment of PHPT should be developed especially for elderly patients. In particular, the early diagnosis and treatment of a transient post-operative thyrotoxicosis could improve recovery. ![]() However, the management of post-operative period should be more careful in fragile patients. Only parathyroid surgery has been demonstrated to cure PHPT and complications related, showing similar outcome between older and younger patients. A functional chronic hypercortisolism could be established, enhancing PHPT related disorders. ConclusionĬhronic hyperparathyroidism has been linked with increased all-cause mortality. The patient also presented a transient hypercortisolism with elevated ACTH, likely due to stress related not only to aging and hospitalization but also to PHPT, resolved only four months after parathyroid surgery. A short-term treatment with beta-blockers was introduced for symptomatic relief. Parathyroid surgery was successfully performed, but patient’s conditions suddenly worsened because of a transient thyrotoxicosis, probably induced by a previous exposure to iodine load and/or thyroid surgical manipulation. He was treated with hydration, zoledronic acid, cinacalcet and high-dose unfractionated heparin. We report the case of an elderly patient with symptomatic PHPT and incidental pulmonary embolism. Being PHPT frequently found in the 6 th to 7 th decade of life, a careful and multifaceted approach should be taken. However many studies suggest different systemic effects related to PHPT, which could be enhanced by an abnormal cortisol release due to chronic stress of hyperparathyroidism. Primary hyperparathyroidism (PHPT) is often found on routine blood tests, at a relatively asymptomatic stage.
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