Sclerochoroidal Calcification: Parathyroid Connection

Abstract

Objective: Sclerochoroidal calcification is a benign condition often noted incidentally on ophthalmoscopic examination of the fundus. It may be associated with metabolic disorders such as hyperparathyroidism, Gitelman syndrome, pseudo hypoparathyroidism. Here we present a case of asymptomatic Sclerochoroidal calcification incidentally found on a routine fundoscopic examination of a patient with diabetes and primary hyperparathyroidism. Methods: The following is a case report with a review of the literature. Results: 62 year old Caucasian male was referred to Endocrine section from ophthalmology for work up of possible secondary causes of an incidental finding of sclerochoroidal calcification noted on routine exam for diabetic retinopathy in 2015. The lesion was present in prior fundus photos from 2011 with no significant changes, indicating stability of the lesion over the last 4 years. Ophthalmic exam noted all normal findings for pupillary reaction, extraocular motility, intra ocular pressures, visual fields and acuity of vision was 20/20 in both eyes and there was no evidence of diabetic retinopathy on dilated fundus exam. An incidental finding of an elevated round yellow lesion superior to the optic nerve head was noted on the fundus exam in the left eye behind the lesion consistent with dense intra-lesional calcification. The lesion did not demonstrate any abnormal vasculature, pigmentation, or retinal fluid. Ophthalmic ultrasonography testing revealed hyper-reflectivity with acoustic shadowing. On work up found to have primary hyperparathyroidism. Whether they are related or incidental problems together is not clear. Conclusion: Though Sclerochoroidal calcification can be idiopathic in most cases, clinicians are advised to rule out metabolic disorders such as abnormal calcium and phosphorous metabolism.