Case history
Case history
At a routine examination, a 55-year-old woman is discovered to have hypercalcaemia. Follow-up laboratory tests show synchronously elevated serum calcium and intact parathyroid hormone, with low phosphorus and mildly elevated alkaline phosphatase. 25-hydroxyvitamin D is in the low normal range. Past medical history is significant for hypertension and coronary artery disease. Review of symptoms includes complaints of fatigue, feeling achy, and vague depression and mental fatigue. The patient has a history of nephrolithiasis and newly detected osteopenia. Family history is negative for renal stones or calcium disorders.
Other presentations
The clinical presentation of PHPT has shifted over time, with over 80% of patients in the US and Western Europe diagnosed incidentally when hypercalcaemia is detected on laboratory tests done for other reasons.[6] In countries where screening blood testing is not as common, patients with PHPT are more likely to present with symptomatic disease, such as bone pain or renal colic.[6] People with multiple endocrine neoplasia, type 1 (MEN 1) most commonly present with PHPT.[7] They may have a history of nephrolithiasis at an early age (<40 years) or a family history of PHPT or pancreatic or pituitary tumours.[7]
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