title: Hyperparathyroidism with hypercalcaemia in chronic kidney disease: primary or tertiary?
abstract: Objective . This study aims to highlight the challenges in the diagnosis of hyperparathyroidism (HPT) in patients with advanced chronic kidney disease (CKD). Methods . In this report, we describe a middle-aged Filipino gentleman with underlying CKD who presented with intractable nausea, vomiting, severe and medically refractory hypercalcaemia and parathyroid hormone (PTH) concentrations in excess of 2400 pg/mL. The underlying pathophysiology as well as the aetiologies and current relevant literature are discussed. We also suggest an appropriate diagnostic approach to identify and promptly treat patients with CKD, HPT and hypercalcaemia. Results . Evaluation confirmed the presence of a large parathyroid adenoma; HPT and hypercalcaemia resolved rapidly following resection. Conclusion . This case report is remarkable for its severe hypercalcaemia requiring haemodialysis, large adenoma size, acute-on-chronic kidney injury and markedly elevated PTH concentration in association with primary HPT in CKD.
authors.affiliation: Department of Medicine , Stanford University School of Medicine , 300 Pasteur Drive, Stanford, CA, 94305 , USA.
authors.forename: Mitchell R
authors.initials: MR
authors.lastname: Lunn
authors.affiliation: Department of Medicine , Stanford University School of Medicine , 300 Pasteur Drive, Stanford, CA, 94305 , USA ; Division of Nephrology, Department of Medicine , Stanford University Medical Center , 780 Welch Road, Suite 106, Palo Alto, CA, 94304 , USA.
authors.forename: Jair
authors.initials: J
authors.lastname: Muñoz Mendoza
authors.affiliation: Department of Pathology , Stanford University Medical Center , 300 Pasteur Drive, Stanford, CA, 94305 , USA.
authors.forename: Lezlee J
authors.initials: LJ
authors.lastname: Pasche
authors.affiliation: Department of Surgery , Stanford University Medical Center , 300 Pasteur Drive, Stanford, CA, 94305 , USA.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Norton
authors.affiliation: Department of Medicine , Makati Medical Center , 2 Amorsolo Street, Makati City, Manila , Philippines.
authors.forename: Alexander L
authors.initials: AL
authors.lastname: Ayco
authors.affiliation: Department of Medicine , Stanford University School of Medicine , 300 Pasteur Drive, Stanford, CA, 94305 , USA ; Division of Nephrology, Department of Medicine , Stanford University Medical Center , 780 Welch Road, Suite 106, Palo Alto, CA, 94304 , USA.
authors.forename: Glenn M
authors.initials: GM
authors.lastname: Chertow
keywords: PTH; parathyroid adenoma; parathyroid hormone; primary hyperparathyroidism; tertiary hyperparathyroidism