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Coexistance of primary hyperparathyroidism and sarcoidosis in a hypercalcemic patient

https://doi.org/10.14341/probl13550

Abstract

This clinical case demonstrates difficulties in managing patients with newly diagnosed hypercalcemia. Depending on the involvement of parathyroid hormone (PTG) in the mechanisms of hypercalcemia the latter is divided into parathyroid hormone-dependent (PTH-dependent) and parathyroid hormone-independent (PTH-independent). In this clinical case an analysis of clinical, laboratory and instrumental data revealed a rare combination of PTH-dependent and PTH-independent hypercalcemia. A 74-year-old patient was diagnosed with primary hyperparathyroidism (PHPT) which was the cause of severe hypercalcemia. Persistence of hypercalcemia after surgical treatment and normalisation of PTH levels required further diagnostic search and exclusion of other causes of hypercalcemia. As a result, sarcoidosis with lesions of the mediastinal and cervical lymph nodes was revealed. Methylprednisolone was administered in the treatment regimen, which gradually normalised serum calcium levels.

About the Authors

L. I. Danilova
Belarusian State Medical University
Беларусь

Larisa I. Danilova, MD, PhD, Professor

Minsk



G. G. Korolenko
Belarusian State Medical University
Беларусь

Galina G. Korolenko, MD, PhD

73 Uborevich street, 220096 Minsk



M. L. Lushchyk
Belarusian State Medical University
Беларусь

Maxim L. Lushchyk, MD, PhD

Minsk



I. I. Bourko
Belarusian State Medical University
Беларусь

Irina I. Bourko, MD, PhD

Minsk



A. A. Ramanouski
Belarusian State Medical University
Беларусь

Aliaksei A. Ramanouski, MD, PhD

Minsk



S. V. Yakubouski
Belarusian State Medical University
Беларусь

Siarhei V. Yakubouski, MD, PhD

Minsk



O. N. Isachkina
10th City Clinical Hospital
Беларусь

Olga N. Isachkina

Minsk

 



References

1. Walker MD, Shane E. Hypercalcemia: A Review. JAMA, 2022;328(16):1624–1636. doi: https://doi.org/10.1001/jama.2022.18331

2. Corin H. Hypercalcemia – clinical diagnosis and management. Acta Endocrinol (Buchar). 2022;18(1):138. doi: https://doi.org/10.4183/aeb.2022.138

3. Bentana Y, Benabdelhak M, Haddiya I, at al. Severe hypercalcemia requiring acute hemodialysis: A retrospective cohort study with increased incidence during the Covid-19 pandemic. Am J Emerg Med. 2022;51:374–377. doi: https://doi.org/10.1016/j.ajem.2021.11.013

4. Chouhani B, Allata Y, Chouhani W, at al. Hypercalcemia: Is Dialysis Still an Option? Open J Endocr Metab Dis.,2022;12:103–111. doi: https://doi.org/10.4236/ojemd.2022.124008

5. Yeh MW, Ituarte PH, Zhou HC, et al. Incidence and prevalence of primary hyperparathyroidism in a racially mixed population. J Clin Endocrinol Metab. 2013;98(3):1122–1129. doi:10.1210/jc.2012-4022

6. Mokrysheva NG, Eremkina AK, Mirnaya SS, et al. The clinical practice guidelines for primary hyperparathyroidism, short version. Problems of Endocrinology. 2021;67(4):94-124. (In Russ.) doi: https://doi.org/10.14341/probl12801

7. Roodman DG, Silbermann R. Mechanisms of osteolytic and osteoblastic skeletal lesions. Bonekey Rep. 2015;4:753. doi: https://doi.org/10.1038/bonekey.2015.122

8. Ayyad M, Khaleel M, Albandak M, at al. Concurrent Primary Hyperparathyroidism and Sarcoidosis in a Patient With Severe Hypercalcemia. Cureus. 2023;15(9):e44669. doi: https://doi.org/10.7759/cureus.44669

9. Arribas M., Santor A., Ernesto J. Sarcoidosis and Primary Hyperparathyroidism. AMU. 2015;3:24–27 URI: http://hdl.handle.net/10481/69322

10. Bilezikian JP, Khan AA, Silverberg SJ, et al. Evaluation and management of primary hyperparathyroidism: summary statement and guidelines from the Fifth International Workshop. J Bone Miner Res. 2022;37(11):2293-2314. doi: https://doi.org/10.1002/jbmr.4677

11. Bollerslev J, Rejnmark L, Zahn A, et al. European expert consensus on practical management of specific aspects of parathyroid disorders in adults and in pregnancy: recommendations of the ESE educational program of parathyroid disorders. Eur J Endocrinol. 2022;186(2):R33-R63. doi: https://doi.org/10.1530/EJE-21-1044

12. Moosgaard B, Vestergaard P, Heickendorff L, et al. Vitamin D status, seasonal variations, parathyroid adenoma weight and bone mineral density in primary hyperparathyroidism. Clin Endocrinol (Oxf). 2005;63(5):506-513. doi: https://doi.org/10.1111/j.1365-2265.2005.02371.x

13. Mkrtumyan AM. Emergency endocrinology: textbook / A.M. Mkrtumyan, A.A. Nelaeva. 3rd ed., rev. Moscow: GEOTAR-Media, 2022. – 128 p. (In Russ.)

14. Kuznetsov NS, Kim IV, Kuznetsov SN. Intraoperative parathyroid hormone in strategy of surgical treatment of a primary hyperparathyreosis. Endocrine Surgery. 2011;5(2):18–25. (In Russian) doi: https://doi.org/10.14341/2306-3513-2011-2-18-25

15. Witteveen JE, van Thiel S, Romijn JA, Hamdy NA. Hungry bone syndrome: still a challenge in the post-operative management of primary hyperparathyroidism: a systematic review of the literature. Eur J Endocrinol. 2013;168(3):R45-R53. doi: https://doi.org/10.1530/EJE-12-0528

16. Carsote M, Nistor C. Forestalling hungry bone syndrome after parathyroidectomy in patients with primary and renal hyperparathyroidism. Diagnostics (Basel). 2023;13(11):1953. doi: https://doi.org/10.3390/diagnostics13111953

17. Lee IT, Sheu WH, Tu ST, Kuo SW, Pei D. Bisphosphonate pretreatment attenuates hungry bone syndrome postoperatively in subjects with primary hyperparathyroidism. J Bone Miner Metab. 2006;24(3):255-258. doi: https://doi.org/10.1007/s00774-005-0680-x

18. Corsello SM, Paragliola RM, Locantore P, et al. Post-surgery severe hypocalcemia in primary hyperparathyroidism preoperatively treated with zoledronic acid. Hormones (Athens). 2010;9(4):338–342. doi: https://doi.org/10.14310/horm.2002.1286

19. Maier JD, Levine SN. Hypercalcemia in the Intensive Care Unit: A Review of Pathophysiology, Diagnosis, and Modern Therapy. J Intensive Care Med. 2015;30(5):235–252. doi: https://doi.org/10.1177/0885066613507530

20. Gianella F, Hsia CC, Sakhaee K. The role of vitamin D in sarcoidosis. Fac Rev. 2020;9:14. doi: https://doi.org/10.12703/b/9-14

21. Ren S, Nguyen L, Wu S, Encinas C, Adams JS, Hewison M. Alternative splicing of vitamin D-24-hydroxylase: a novel mechanism for the regulation of extrarenal 1,25-dihydroxyvitamin D synthesis. J Biol Chem. 2005;280(21):20604–20611. doi: https://doi.org/10.1074/jbc.M414522200

22. Kuchay MS, Mishra SK, Bansal B, et al. Glucocorticoid sparing effect of zoledronic acid in sarcoid hypercalcemia. Arch Osteoporos. 2017;12(1):68. doi: https://doi.org/10.1007/s11657-017-0360-1

23. Chuchalin AG, Avdeev SN, Aisanov ZR, et al. Sarcoidosis: federal clinical guidelines for diagnosis and treatment. Pul’monologiya. 2022;32(6):806–833 (in Russian). doi: https://doi.org/10.18093/0869-0189-2022-32-6-806-833


Supplementary files

Review

For citations:


Danilova L.I., Korolenko G.G., Lushchyk M.L., Bourko I.I., Ramanouski A.A., Yakubouski S.V., Isachkina O.N. Coexistance of primary hyperparathyroidism and sarcoidosis in a hypercalcemic patient. Problems of Endocrinology. 2025;71(6):22-30. (In Russ.) https://doi.org/10.14341/probl13550

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ISSN 0375-9660 (Print)
ISSN 2308-1430 (Online)