BIOCHEMICAL WITH NORMAL PARATHYROID HORMONE : A CASE REPORT

Abstract

Normo-hormonal primary hyperparathyroidism(NPHPT) is an uncommon condition which has been increasing in last decade. This milder biochemical entity remains incompletely understood due to lack of long term health outcomes regarding management. NPHPT poses two challenges to the surgeon, rst is when to operate and second is the use of intra-operative parathyroid hormone assay to predict the success of surgery. Here we present a 53 year old lady who came with low back ache of more than 2 years duration. It is found to have elevated calcium levels and on further evaluation found to have high normal parathyroid hormone levels in two occasions. Pre operative localization studies were done by suspecting normo-hormonal hyperparathyroidism which showed concordant lesions in both ultrasound neck and Sestamibi scan. She underwent focused parathyroidectomy with intra-operative parathyroid hormone levels which dropped in to less than 30pg/ml. Postoperative calcium was within normal limits and she was symptomatically better. In patients with symptoms of hypercalcemia, elevated calcium levels and high normal intact parathyroid hormone levels should be considered as inappropriate and should lead to the suspicion of normo-hormonal hyperparathyroidism. Intra operative parathyroid hormone levels below 30pg/ml can be utilized as an indicator of successful operation in normo-hormonal hyperparathyroidism.In symptomatic hypercalcemic patients, even if the parathyroid hormones are high normal, a further investigation should be done to locate the parathyroid adenoma and surgery is the best cure