Surgically Proven Normocalcemic Primary Hyperparathyroidism: Speculation of the Possible Role of Estrogen in the Etiology of this Disease in Premenopausal Women

Abstract

We herein report a rare case of surgically proven normocalcemic primary hyperparathyroidism (NCHPT). A premenopausal 51-year-old woman was referred to our clinic because parathyroid adenoma was detected on neck ultrasonography (US). The patient's serum calcium concentration was 9.3 mg/dL and the intact parathyroid hormone (PTH) level was 128.8 pg/mL. The findings of almost all other examinations were also compatible with a diagnosis of NCHPT. Then, parathyroidectomy was performed. The serum calcium and PTH concentrations reduced significantly but remained within the normal ranges. A histological examination demonstrated parathyroid adenoma. A review of this case and the associated literature suggests that estrogen plays a significant role in the etiology of NCHPT in premenopausal women.

Does Bariatric Surgery Increase the Formation of Parathyroid Adenoma

“…21 Tachibana et al suggested that estrogen plays a role in the pathogenesis of normocalcemic primary hyperparthyroidism in premenopausal women by regulating calcium supply from bone. 22 In our study, all of the patients with PA were female and had hypercalcemia, only two patients were in menopause. However, our study design was not planned to establish a relationship between estrogen and calcium levels.…”

Case Report: Normocalcemic Hyperparathyroidism

“…Specific repletion recommendations are not available from clinical trial data. Until such information becomes available, cautiously repleting vitamin D in patients with underlying hyperparathyroidism is recommended since worsening hypercalcemia and hypercalciuria have been reported [8]- [14].…”