Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists · 1996
Coexisting hyperthyroidism and primary hyperparathyroidism with vitamin D-deficient osteomalacia in a Vietnamese immigrant.
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Luong K V, Nguyen L T
Аннотация
OBJECTIVE: To present the first report of concurrent hyperthyroidism, primary hyperparathyroidism (PHP), and vitamin D-deficient osteomalacia.
METHODS: We describe the complicated clinical course in a 65-year-old Vietnamese immigrant, and underlying factors potentially contributing to her condition are discussed.
RESULTS: Our patient, who had hyperthyroidism and hypercalcemia, was found to have an inappropriately high level of intact parathyroid hormone (PTH) because of a parathyroid adenoma, detected on a parathyroid scan. With propranolol treatment, however, improvement was noted in both laboratory data--intact PTH, ionized calcium, serum total calcium, 1,25-dihydroxyvitamin D3 [1,25(OH)2D3], and urinary cyclic adenosine monophosphate--and findings on ultrasonography and nuclear parathyroid scanning. Later, the adenoma was removed surgically. The improvement of PHP after administration of a beta-adrenergic blocker suggested that the parathyroid adenoma in this patient was not completely autonomous. The patient also had vitamin D-deficient osteomalacia that was confirmed by a low serum level of 25-hydroxyvitamin D3 (25OHD3) and by bone histomorphometry. This coexisting condition was caused by the long-term increase in conversion of 25OHD3 to 1,25(OH)2D3 from hyperparathyroidism in a patient with low stores of vitamin D (which were ascribed to aging, liver dysfunction in hyperthyroidism, a vegetarian diet, deprivation of sunlight, and avoidance of dairy products).
CONCLUSION: The complex concurrence of hyperthyroidism, PHP, and vitamin D-deficient osteomalacia is rare but possible.
METHODS: We describe the complicated clinical course in a 65-year-old Vietnamese immigrant, and underlying factors potentially contributing to her condition are discussed.
RESULTS: Our patient, who had hyperthyroidism and hypercalcemia, was found to have an inappropriately high level of intact parathyroid hormone (PTH) because of a parathyroid adenoma, detected on a parathyroid scan. With propranolol treatment, however, improvement was noted in both laboratory data--intact PTH, ionized calcium, serum total calcium, 1,25-dihydroxyvitamin D3 [1,25(OH)2D3], and urinary cyclic adenosine monophosphate--and findings on ultrasonography and nuclear parathyroid scanning. Later, the adenoma was removed surgically. The improvement of PHP after administration of a beta-adrenergic blocker suggested that the parathyroid adenoma in this patient was not completely autonomous. The patient also had vitamin D-deficient osteomalacia that was confirmed by a low serum level of 25-hydroxyvitamin D3 (25OHD3) and by bone histomorphometry. This coexisting condition was caused by the long-term increase in conversion of 25OHD3 to 1,25(OH)2D3 from hyperparathyroidism in a patient with low stores of vitamin D (which were ascribed to aging, liver dysfunction in hyperthyroidism, a vegetarian diet, deprivation of sunlight, and avoidance of dairy products).
CONCLUSION: The complex concurrence of hyperthyroidism, PHP, and vitamin D-deficient osteomalacia is rare but possible.