HYPERPARATHYRO?DIE PRIMAIRE R?V?L?E PAR COLIQUE N?PHR?TIQUE

Introduction: The most common clinical presentation of primary hyperparathyroidism is asymptomatic hypercalcemia detected during routine biological evaluation. Atypical forms include normocalcemic primary hyperparathyroidism and parathyroid crisis, but classical manifestations are still common. Observation: A 65-year-old hypertensive man stabilized with monotherapy consulted for left renal colic. Biological assessment noted anemia, minimal renal failure, significant hypercalcemia and hypophosphatemia. Radiological assessment, in particular abdominal CT scan, revealed left renal calculi with dilated upper calyceal cavities, as well as two brown tumors of the pelvis. The diagnosis of bone metastases was first suggested, but serum parathyroid hormone testing showed very high levels of parathyroid hormone making the diagnosis of hyperparathyroidism. The cervical scanner revealed a large parathyroid adenoma. The patient benefited from extracorporeal lithotripsy, which eliminated kidney stones, the nature of which was calcium oxalate. Then, a parathyroidectomy was performed and the parathyroid hormone postoperatively normalized. The patient continued to present sometimes, cramps and tingling in the extremities, treated with calcium carbonate and calcitriol. Bone lesions spontaneously regressed dramatically, renal function remained close to normal, and anemia corrected without iron administration. Conclusion: This observation illustrates that even with an advanced degree of progression, hyperparathyroidism can remain asymptomatic despite the intensity of the impact on affected organs.