Hyperparathyroidism due to Parathyroid Adenoma with Co-existing Vitamin D Deficiency – A Case Report

Primary hyperparathyroidism is often asymptomatic, may be detected during routine investigations or may present with features of hypercalcaemia. Vitamin D deficiency causing secondary hyperparathyroidism presents with musculoskeletal symptoms. Studies have shown an association between primary hyperparathyroidism and vitamin D deficiency. It has also been observed that when co-exist, these two conditions contribute to each other’s disease presentation and severity. This case report depicts initial asymptomatic hyperparathyroidism developing symptoms due to co-existing parathyroid adenoma and vitamin D deficiency in a 26-year-old muslim Bangladeshi female who responded well to adequate pre, per and post parathyroidectomy medical managementBirdem Med J 2015; 5(2): 104-106

Is surgery necessary for ‘mild’ or ‘asymptomatic’ hyperparathyroidism?

A large majority of the currently diagnosed patients with hyperparathyroidism (PHPT) are mild or asymptomatic, mainly women after menopause. Following the debate held at the 16th European Congress of Endocrinology in Wroclaw (Poland) from May 3–7, 2014, arguments are here presented by a surgeon and a medical practitioner considering these situations rather have to profit from surgery, or simply from survey. For the trained endocrine surgeon, it is evident that parathyroidectomy confirms the diagnosis and undoubtedly reduces the discomfort felt by certain patients, prevents all risks of complications, removes patients and medical teams from the monitoring and represents a real individual financial benefit. On the other hand, the medical practitioner considers that mild or asymptomatic PHPT is commonly stable, and very rare are the subjects at risk of complications, particularly of fractures; prevention of vascular and metabolic disorders, nephrolithiasis and bone rarefaction justify regular physical exercise, a safe alimentation, a sufficient calcium and high water intake, the correction of the frequent deficit in vitamin D; finally has also to be considered the impossibility to refer to specialized (endocrine) surgeons, the enormous cohort of subjects more than 50 years with ‘mild’ or ‘asymptomatic’ PHPT. The surgeon and the medical practitioner agree to consider that in patients with ‘mild’ or ‘asymptomatic’ disease, there is no place for medical treatments, in particular calcimimetics and bisphophonates. Both agree that further studies are needed to clarify the long-term prognosis of operated and non-operated PHPT in term of fractures, cardiovascular risk and mortality. Individual and collective cost/benefit ratios of surgery or survey are also still imperfectly evaluated.