Challenges of Parathyroidectomy in a Patient with Primary Hyperparathyroidism and End Stage Renal Disease- Case Report.

Abstract

Hyperparathyroidism is an endocrinopathy affecting calcium metabolism. The leading cause of hypercalcaemia is primary hyperparathyroidism most often caused by a parathyroid adenoma. Symptomatic hyperclacemia secondary to parathyroid adenoma is usually managed by surgical excision of the adenoma1,2. We present a 54 year old female patient who presented with palpitations, general body malaise, nausea and headache on her index admission and managed for severe hypertension. She had been treated for hypertension for three years but with poor adherence to follow-up and medication. During her laboratory work up, her total calcium level was found to be elevated at 3.82mmols/l (2.2-2.5mmols/l).Her albumin level was normal. In addition, she was diagnosed with end stage renal disease and haemodialysis instituted. Parathyroid mass was diagnosed on a parathyroid 99Tc methoxyisobutylisonitrile (MIBI) scan. Parathyroidectomy was performed two months later and diagnosis of parathyroid adenoma was confirmed on histology of the excised tissues. Hypercalcemia resolved after the excision. The case report aims to highlight the challenges in the management of hyperparathyroidism in a patient with end stage renal disease scheduled for parathyroidectomy in a resource restricted tertiary hospital