Added Value of Geriatric Consultation on the Emergency Department to Detect Primary Hyperparathyroidism in the Elderly Presenting as Frail Phenotype: Review of the Literature and A Case Report

A geriatric syndrome manifests itself as a group of signs and symptoms such as functional decline or cognitive problems leading to a vulnerable or frail phenotype. Here we present the case of an older woman with primary hyperparathyroidism masked by a frail phenotype detected during the geriatric consultation at the emergency department. A 75-year-old woman with a history of hypertension, hypercholesterolemia, diabetes mellitus type 2, morbid obesity, non-alcoholic fatty liver disease, and secondary hyperparathyroidism due to vitamin D deficiency, presented at the emergency department with progressive fatigue, weakness, confusion, and cognitive decline over the last weeks. Previous consultation at the emergency department of another hospital a week earlier had not yielded a clear diagnosis. Geriatric assessment revealed severe frailty, functional dependence and neurocognitive decline. Blood tests revealed severe hypercalcemia (3.71 mmol/L), hypophosphatemia (0.35 mmol/L), and elevated PTH (492 ng/L). Parathyroid 4D scintigraphy and CT scan showed a possible parathyroid adenoma and multiple thyroid nodules. The patient underwent parathyroidectomy and subtotal thyroidectomy. Pathology revealed a parathyroid adenoma confirming the diagnosis of primary hyperparathyroidism, and papillary thyroid carcinoma. She was discharged after 22 days, and full functional and neurocognitive recovery was confirmed after 12 months. Geriatric consultation on the emergency ward is of key importance. Clinical decisions in older people are indeed complex and require multidisciplinary input where experience of geriatricians provides important added value.