Beyond secondary hyperparathyroidism: Diagnosing primary parathyroid abnormalities in a patient with chronic kidney disease

Abstract

Chronic kidney disease (CKD) is a complex medical condition that extends beyond the progressive decline in renal function. It is associated with mineral and bone disorders, notably secondary hyperparathyroidism due to dysregulated calcium and phosphate metabolism. However, distinguishing between secondary and primary hyperparathyroidism can be challenging. We report the case of a 74-year-old male with CKD, who presented with elevated serum levels of parathyroid hormone (PTH), CKD, and unexplained hypercalcemia, despite management for secondary hyperparathyroidism. Advanced imaging techniques revealed a primary parathyroid adenoma, subsequently confirmed by histopathology. The successful surgical resection of the adenoma resulted in the calcium and PTH levels falling into a normal range, highlighting the need for a careful differential diagnosis in CKD patients.