Hypercalcemia and Chronic Renal Failure: a Case of Tertiary Hyperparathyroidism

Background: Hyperparathyroidism is a clinical condition related to the excessive synthesis and secretion of the parathyroid hormone secreted by the parathyroid glands. It exerts a hypercalcemic effect. We distinguish three forms of hyperparathyroidism: primary, secondary and tertiary [1]. Case history: We report the case of a 79-year-old woman who came to our observation for asthenia, osteoarticular pain, and anaemia, suffering from chronic renal failure (IV stage). Blood chemistry tests show macrocytic anaemia with normal reticulocytes and haptoglobin, and vitamin B12 deficiency, increased creatinine, azotemia, and hypercalcemia. An ultrasound scan of the thyroid and parathyroid glands is then performed, showing a hypoechoic nodule of possible parathyroid relevance in the right lobe in the basal area. A high parathyroid hormone dosage is performed; therefore, parathyroid scintigraphy is performed with Sestamibi, confirming the suspicion of parathyroid adenoma. We then performed the cytological examination of the nodule at the base of the right thyroid lobe and intranodular dosage of the parathyroid hormone. Both samples were consistent with the diagnosis of adenomatous/hyperplastic parathyroid nodule. Discussion: The authors investigated the finding of hypercalcemia and chronic renal failure to identify parathyroid hyperplasia, a condition that identifies tertiary hyperparathyroidism. References 1 Palumbo VD, Palumbo VD, Damiano G, Messina M, Fazzotta S, et al. (2021) Tertiary hyperparathyroidism: a review. AI.Clin Ter 172: 241- 246.

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