Coexistance of primary hyperparathyroidism and sarcoidosis in a hypercalcemic patient
L. I. Danilova,
G. G. Korolenko,
M. L. Lushchyk,
I. I. Bourko,
A. A. Ramanouski,
S. V. Yakubouski,
O. N. Isachkina 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
Belarus
Belarus
Larisa I. Danilova, MD, PhD, Professor
Minsko
G. G. Korolenko
Belarusian State Medical University
Belarus
Belarus
Galina G. Korolenko, MD, PhD
73 Uborevich street, 220096 Minsk
M. L. Lushchyk
Belarusian State Medical University
Belarus
Belarus
Maxim L. Lushchyk, MD, PhD
Minsk
I. I. Bourko
Belarusian State Medical University
Belarus
Belarus
Irina I. Bourko, MD, PhD
Minsk
A. A. Ramanouski
Belarusian State Medical University
Belarus
Belarus
Aliaksei A. Ramanouski, MD, PhD
Minsk
S. V. Yakubouski
Belarusian State Medical University
Belarus
Belarus
Siarhei V. Yakubouski, MD, PhD
Minsk
O. N. Isachkina
10th City Clinical Hospital
Belarus
Belarus
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
|
|
1. Figure 1. Thyroid ultrasound: a nodular lesion in the left lobe of the thyroid gland, measuring 12.2 x 14.0 x 18.6 mm, isoechoic, heterogeneous, and containing calcifications. | |
| Subject | ||
| Type | Результаты исследования | |
View
(507KB)
|
Indexing metadata ▾ | |
|
|
2. Figure 2. Parathyroid ultrasound: a lesion in the location of the right parathyroid gland, measuring 21.5 x 7.8 x 11.3 mm, irregularly shaped, heterogeneous, and hypoechoic. | |
| Subject | ||
| Type | Исследовательские инструменты | |
View
(485KB)
|
Indexing metadata ▾ | |
|
|
3. Figure 3. Neck lymph node ultrasound: a lymph node in the supraclavicular region, measuring 14.5 x 14.1 mm, irregularly shaped, hypoechoic, and lobular. | |
| Subject | ||
| Type | Исследовательские инструменты | |
View
(614KB)
|
Indexing metadata ▾ | |
|
|
4. Figure 4. Serum PTH dynamics, pg/ml. | |
| Subject | ||
| Type | Результаты исследования | |
View
(170KB)
|
Indexing metadata ▾ | |
|
|
5. Figure 5. Postoperative PTH dynamics, pg/ml. Figure 6. Calcemia dynamics, mmol/L. | |
| Subject | ||
| Type | Результаты исследования | |
View
(136KB)
|
Indexing metadata ▾ | |
|
|
6. Figure 6. Calcemia dynamics, mmol/L. | |
| Subject | ||
| Type | Анализ данных | |
View
(363KB)
|
Indexing metadata ▾ | |
|
|
7. Figure 7. Lymph node tissue fragment with disrupted histoarchitecture due to confluent small sarcoid-type granulomas. Hematoxylin and eosin staining, ×200. | |
| Subject | ||
| Type | Исследовательские инструменты | |
View
(810KB)
|
Indexing metadata ▾ | |
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
Views:
690
JATS XML
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND 4.0).
Email this article 
.jpg){kind=logo}
