Nephrolithiasis in hypercalcemic and normocalcemic primary Hyperparathyroidism

Primary hyperparathyroidism (PHPT) is a common condition affecting up to 4 per 1000 of population, and the majority of cases are due to adenoma or hyperplasia of the gland [1]. This endocrine disorder may either develop without symptoms or be classically manifested by anorexia, nausea, constipation, polydipsia and polyuria in association with hypercalcemia [1]. Worthy of note is the form of PHPT described in 2009 and characterized by normocalcemia, which persists with hypercalciuria, nephrolithiasis and bone loss in the majority of the cases 1. Nephrolithiasis can complicate 20% of hypercalcemic and 18.2% of normocalcemic PHPT; moreover, calcium oxalate and calcium phosphate are the main components of the calculi [1]. Thiazide diuretics, lithium salt, immobilization, and inactivity; in addition to hyperoxaluria, hypocitraturia, low urinary pH, high salt ingestion, and low water intake play adverse roles [1]. Cinacalcet hydrochloride is a calciomimetic drug that can activate parathyroid and renal calcium-sensing receptors suppressing synthesis/ secretion of PTH, and reducing calcemia 1. This drug is also used to treat secondary hyperparathyroidism in people with kidney failure [1].