Skip to content
DraconiticResearch
Search Sources API
203,234 studies31 sourcesUpdated 43 min ago
Peer-reviewedCC BY-NC-NDJCEM case reports

Long-term follow-up revealed hypocalciuric hypercalcemia in a patient initially treated for primary hyperparathyroidism.

  • Aida Veronica Araya1,2
  • Juan Dupouy3
  • Patricio Gac4
4 affiliations
  1. 1Endocrinology Unit Clínica Las Condes, Las Condes, Santiago 7591046, Chile.
  2. 2Endocrinology Section Hospital Clínico Universidad de Chile, Independencia, Santiago 7591046, Chile.
  3. 3Center of Nuclear Medicine, Hospital Clínico Universidad de Chile, Independencia, Santiago 8380000, Chile.
  4. 4Department of Surgery, Hospital Clínico Universidad de Chile, Independencia, Santiago 8380000, Chile.
Read full textPDFDOICite

Abstract

In patients with hypercalcemia and normal or mildly elevated parathyroid hormone (PTH) levels, distinguishing primary hyperparathyroidism (PHPT) from hypocalciuric hypercalcemia (HH) is crucial. We describe a 70-year-old woman who underwent parathyroidectomy for PHPT at 58 years old. Despite surgery, she remained asymptomatic with persistent hypercalcemia, normal phosphate levels, 25-hydroxyvitamin D, renal function, and mildly elevated PTH levels. Serial imaging suggested recurrent parathyroid disease, and subtotal parathyroidectomy demonstrated parathyroid hyperplasia. Although serum calcium and PTH levels initially normalized, hypercalcemia later recurred with normal PTH levels. Twenty-four-hour urinary calcium excretion was markedly low, and the calcium-to-creatinine clearance ratio (CCCR) was consistent with HH. No pathogenic variant was detected in the calcium-sensing receptor gene (CASR). At 84 years old, the patient remained asymptomatic. Long-term follow-up supported the diagnosis of HH despite negative CASR testing. This case underscores the importance of measuring 24-hour urinary calcium excretion and calculating the CCCR in patients with hypercalcemia, particularly in asymptomatic individuals, before considering parathyroid surgery.

Related

  1. Severe Hypercalcemia and Acute Kidney Injury in a Patient with Probable IgG4-Related Disease and Cholestatic Liver Injury: A Case Report
    Chi-Hsien Chang, Shang-Feng Tsai
    Journal of clinical medicinePeer-reviewedCC BYFull textGeneral medicineEurope PMC
  2. RUNX1 Familial Platelet Disorder with Associated Myeloid Malignancies Initially Diagnosed as Immune Thrombocytopenia and Reclassified After 10 Years: Diagnostic Pitfall Revealed by a Family History
    Keijiro Sato, Kaori Suzuki, Kenichi Sakamoto +3
    Internal MedicinePeer-reviewedCC BY-NC-NDFull textGeneral medicineJ-STAGE
  3. Severe Hypercalcemia Followed by Profound Hypocalcemia in a Patient With Familial Hypocalcemia and Metastatic Cancer
    Zhanna Zavgorodneva, Jocelyne Karam
    AACE Endocrinology and DiabetesPeer-reviewedCC BY-NC-ND 4.0Full textEndocrinology & metabolismPMC
  4. Rapid Progression of Acute Acalculous Cholecystitis to Gangrenous Cholecystitis in an Initially Non-Critically Ill Patient: A Case Report.
    Rami Y Adam, Sami J Eldein, Mahmoud M Mahmoud +3
    Clinical case reportsPeer-reviewedCC BYFull textGeneral medicineEurope PMCPMCDOAJ
  5. Case Report: Laser thermal ablation for severe primary hyperparathyroidism in a pregnant patient with MEN1 syndrome
    Mateusz Obal, Marcin Motyka, Grzegorz Sokołowski +3
    Frontiers in EndocrinologyPeer-reviewedCC BY 4.0Full textSurgery & anaesthesiaPMCCrossrefEurope PMC

Cite

BibTeXRIS
BibTeX
@article{araya2026longterm,
  title = {{Long-term follow-up revealed hypocalciuric hypercalcemia in a patient initially treated for primary hyperparathyroidism.}},
  author = {Aida Veronica Araya and Juan Dupouy and Patricio Gac},
  journal = {JCEM case reports},
  year = {2026},
  month = oct,
  doi = {10.1210/jcemcr/luag330},
  url = {https://europepmc.org/article/MED/42948683},
  note = {CC BY-NC-ND},
}
RIS
TY  - JOUR
TI  - Long-term follow-up revealed hypocalciuric hypercalcemia in a patient initially treated for primary hyperparathyroidism.
AU  - Aida Veronica Araya
AU  - Juan Dupouy
AU  - Patricio Gac
PY  - 2026
DA  - 2026/10/27
JO  - JCEM case reports
DO  - 10.1210/jcemcr/luag330
UR  - https://europepmc.org/article/MED/42948683
AB  - In patients with hypercalcemia and normal or mildly elevated parathyroid hormone (PTH) levels, distinguishing primary hyperparathyroidism (PHPT) from hypocalciuric hypercalcemia (HH) is crucial. We describe a 70-year-old woman who underwent parathyroidectomy for PHPT at 58 years old. Despite surgery, she remained asymptomatic with persistent hypercalcemia, normal phosphate levels, 25-hydroxyvitamin D, renal function, and mildly elevated PTH levels. Serial imaging suggested recurrent parathyroid disease, and subtotal parathyroidectomy demonstrated parathyroid hyperplasia. Although serum calcium and PTH levels initially normalized, hypercalcemia later recurred with normal PTH levels. Twenty-four-hour urinary calcium excretion was markedly low, and the calcium-to-creatinine clearance ratio (CCCR) was consistent with HH. No pathogenic variant was detected in the calcium-sensing receptor gene (CASR). At 84 years old, the patient remained asymptomatic. Long-term follow-up supported the diagnosis of HH despite negative CASR testing. This case underscores the importance of measuring 24-hour urinary calcium excretion and calculating the CCCR in patients with hypercalcemia, particularly in asymptomatic individuals, before considering parathyroid surgery.
SN  - 2755-1520
ER  -