title: Tuberculosis complicating tertiary hyperparathyroidism in a patient with end-stage renal disease: a case report.
abstract: A 36-year-old Nigerian woman on thrice-weekly dialysis presented with symptoms and signs of hypercalcaemia. Laboratory findings were consistent with tertiary hyperparathyroidism. Parathyroid hormone levels remained elevated and she underwent elective parathyroidectomy. Intra-operatively all 4 parathyroid glands and local lymph nodes showed necrotising granulomas with occasional acid-fast bacilli, pathognomonic of tuberculosis (TB). Post-operatively she completed a full course of anti-TB therapy and at 9 months she experienced complete resolution in her plasma biochemistry and was essentially symptom-free. This is a rare yet fascinating cause of hypercalcaemia in a dialysis patient and is the first recorded case of tubercular involvement of parathyroid tissue in a case of tertiary hyperparathyroidism. This report demonstrates the coexistence of 2 diseases that simultaneously worsened hypercalcaemia and thus emphasises the importance of the differential diagnosis and of careful histological examination post-operation.
authors.affiliation: Department of Nephrology and Transplantation, Guy's Hospital, Guy's and St. Thomas' NHS Trust, London, UK.
authors.forename: Hazim M
authors.initials: HM
authors.lastname: Sadideen
authors.forename: Paul
authors.initials: P
authors.lastname: Blaker
authors.forename: Patrick
authors.initials: P
authors.lastname: O'Donnell
authors.forename: John
authors.initials: J
authors.lastname: Taylor
authors.forename: David J
authors.initials: DJ
authors.lastname: Goldsmith
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D006934:Hypercalcemia / Q000209:etiology; D006961:Hyperparathyroidism / Q000209:etiology*; D006962:Hyperparathyroidism, Secondary / Q000175:diagnosis / Q000209:etiology; D007676:Kidney Failure, Chronic / Q000150:complications*; D010279:Parathyroid Diseases / Q000175:diagnosis*; D014383:Tuberculosis, Endocrine / Q000150:complications* / Q000175:diagnosis*