Coincidence of severe primary hyperparathyroidism and primary hypothyroidism in a postmenopausal woman with low bone mass – initial conservative management

摘要

A 70 year-old Caucasian female (weight 71 kg, BMI 31.6kg/m2) was referred to the outpatient clinics of the Departmentof Endocrinology, 424 Military Hospital, Thessaloniki, Greecebecause of newly diagnosed hip osteopenia.The patient reported weakness, back pain and arthralgieswithout recent fractures and a positive family history of osteo-porosis. Despite her kyphosis, lumbar spine bone mineral den-sity (BMD) was normal (T-score -0.97) while non-dominantfemoral neck BMD was low (T-score -2.12). Plain radiographsof the spine showed kyphosis and a moderate wedge fracture atT7 (Figure 1A). The baseline hematology and biochemistry test-ing revealed normochrome-normocytic anemia (Ht: 33%), se-vere hypercalcaemia and hypophosphataemia with markedlyincreased total alkaline phosphatase and slightly impaired renalfunction (Table 1). Subsequent hormone testing revealedmarkedly increased parathyroid hormone (PTH), normal 25-hy-droxyvitamin D and, surprisingly, severe primary hypothy-roidism [TSH: 54.6 |ìIU/ml, normal range (NR) 0.4-4; FT4 0.37,NR 0.84-1.76]. Although probably unnecessary due to the clear-cut picture of PTH-induced hypercalcemia, testing for othercauses of hypercalcaemia, including protein electrophoresis,bone scintigraphy and mammography, was conducted, in orderto rule out coincidence of primary hyperparathyroidism (pHPT)with other diseases, and turned out to be negative