Consideration of primary hyperparathyroidism in primary care

A sixty-seven-year-old female patient presented with symptomatic hypercalcemia as the first manifestation of primary hyperparathyroidism due to parathyroid adenoma. Initially the chronic hypercalcemia was investigated and then subsequent parathyroidectomy was done. She is doing very well six months following the surgery and the hypercalcemia has resolved completely. Asymptomatic hypercalcaemia due to primary hyperparathyroidism is a common condition in primary care1. Most commonly primary hyperparathyroidism is caused by a solitary parathyroid adenoma (80%), and less frequently multi-glandular adenoma, parathyroid hyperplasia or carcinoma2. Patients rarely present with symptomatic hypercalcemia (mnemonic “stones,” “bones,” “abdominal moans,” and “psychic groans”) whereas usually patients remain asymptomatic and the condition is discovered during routine checkup investigations3. The disorder can occur at any age, yet is more common in the middle age group (≥50 years). The ratio of such cases is equivalent to 1:1000 in males, whereas it is 3:1000 in the female population4.