title: Persistent Primary Hyperparathyroidism, Severe Vitamin D Deficiency, and Multiple Pathological Fractures.
abstract: Persistent primary hyperparathyroidism (PHPT) refers to the sustained hypercalcemia state detected within the first six months following parathyroidectomy. When it coexists with severe vitamin D deficiency, the effects on bone can be devastating. We report the case of a 56-year-old woman who was sent to this center because of persistent hyperparathyroidism. Her disease had over 3 years of evolution with nephrolithiasis and hip fracture. Parathyroidectomy was performed in her local unit; however, she continued with hypercalcemia, bone pain, and pathological fractures. On admission, the patient was bedridden with multiple deformations by fractures in thoracic and pelvic members. Blood pressure was 100/80, heart rate was 86 per minute, and body mass index was 19 kg/m(2). Calcium was 14 mg/dL, parathormone 1648 pg/mL, phosphorus 2.3 mg/dL, creatinine 2.4 mg/dL, urea 59 mg/dL, alkaline phosphatase 1580 U/L, and vitamin D 4 ng/mL. She received parenteral treatment of hypercalcemia and replenishment of vitamin D. The second surgical exploration was radioguided by gamma probe. A retroesophageal adenoma of 4 cm was resected. Conclusion. Persistent hyperparathyroidism with severe vitamin D deficiency can cause catastrophic skeletal bone softening and fractures.
authors.affiliation: Endocrinology Department, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, IMSS, 06720 Mexico City, DF, Mexico.
authors.forename: Victoria
authors.identifier: 0000-0002-5394-9856
authors.initials: V
authors.lastname: Mendoza-Zubieta
authors.affiliation: Faculty of Medicine, Universidad Nacional Autónoma de México (UNAM), 04510 Mexico City, DF, Mexico.
authors.forename: Mauricio
authors.initials: M
authors.lastname: Carvallo-Venegas
authors.affiliation: Faculty of Medicine, Universidad Nacional Autónoma de México (UNAM), 04510 Mexico City, DF, Mexico.
authors.forename: Jorge Alberto
authors.initials: JA
authors.lastname: Vargas-Castilla
authors.affiliation: Faculty of Medicine, Universidad Nacional Autónoma de México (UNAM), 04510 Mexico City, DF, Mexico.
authors.forename: Nicolás
authors.identifier: 0000-0002-7120-0603
authors.initials: N
authors.lastname: Ducoing-Sisto
authors.affiliation: Faculty of Medicine, Universidad Nacional Autónoma de México (UNAM), 04510 Mexico City, DF, Mexico.
authors.forename: Alfredo Alejandro
authors.identifier: 0000-0002-1534-7096
authors.initials: AA
authors.lastname: Páramo-Lovera
authors.affiliation: Endocrinology Department, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, IMSS, 06720 Mexico City, DF, Mexico.
authors.forename: Lourdes Josefina
authors.initials: LJ
authors.lastname: Balcázar-Hernández
authors.affiliation: Division of Medicine, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, IMSS, 06720 Mexico City, DF, Mexico.
authors.forename: Julián Malcolm Mac
authors.initials: JM
authors.lastname: Gregor-Gooch