PS-R03-8: PARATHYROID ADENOMA PRESENTING AS UNEXPLAINED SINUS TACHYCARDIA AND REFRACTORY HYPERTENSION: A CASE REPORT

Abstract

Introduction: Primary hyperparathyroidism (PHPT) and malignancy account for most cases of hypercalcemia in clinical practice. They commonly occur in relation to a solitary parathyroid adenoma, parathyroid hyperplasia, or carcinoma. Majority of patients are asymptomatic, although some present with vague unusual symptoms. Case: We report a case of a 50-year-old lady presenting with unexplained resting tachycardia, uncontrolled hypertension and generalised ill-health for one year in the background of complicated type 2 diabetes, dyslipidaemia, and hypertension. She had marginally elevated serum ionized calcium with normal serum phosphate levels in the background of early chronic kidney disease. Intact parathyroid hormone level was elevated with concomitant low levels of vitamin D. Clinical evaluation revealed an anterior neck lump which was ultrasonically suspected as a thyroid enlargement with possibility of a deep-seated parathyroid mass. A sestamibi B scan confirmed the presence of a single parathyroid adenoma. The possibility of Multiple Endocrine Neoplasia (MEN) was ruled out. She underwent a successful partial thyroidectomy with removal of the parathyroid mass. Histology revealed a solitary benign parathyroid adenoma. Following surgery, her calcium levels returned to normal range and her unexplained tachycardia had settled, as well as her general wellbeing. Her blood pressure was controlled with 3 antihypertensive drugs. Discussion: Hypercalcemia should be suspected as a rare possibility in the workup of unexplained sinus tachycardia and hypertension, and could be masked with concomitant vitamin D deficiency.