SUDDEN SEVERE HYPERTENSION: AN ATYPICAL MANIFESTATION OF PRIMARY HYERPARATHYROIDISM. A CASE REPORT

FERRIER C 1, CATTANEO F1, SOLCA C1, BRUNO V2

1Clinica Moncucco, Lugano Switzerland; 2University Hospital, Berne, Switzerland

Background: Calcium plays an important role in blood pressure (BP) regulation, probably through a direct effect on cardiovascular contractility. Hypercalcemia may rise BP by increasing adrenergic activity and vascular reactivity. Primary hyperparathyroidism(PHPT)-associated hypercalcemia is often asymptomatic and detected by routine blood tests. Although hypertension is common in PHPT, the clinical manifestation of PHPT may be atypical.

Case Report: We report a case of a 56 year old Caucasian woman with no H/O hypertension presenting sudden onset of vertigo with severe hypertension. Medical history was otherwise unremarkable, and clinical examination showed a BP of 215/150mmHg and a BMI of 32.2 kg/m2. Initial laboratory data revealed an elevated total serum calcium (2.79 mmol/l), low phosphate (0.83 mmol/L) and normal 24hr urinary calcium excretion (3.4 mmol/day). Other laboratory and radiological examinations excluded a vascular, renal (PCr 73mcmol/L, no proteinuria, normal urinary sediment), thyroid and adrenal disease and/or a pheochromocytoma. Further evaluation for suspected PHPT showed an elevated iPTH level of 182 ng/L (Normal range: 22.5-105) and a left parathyroid adenoma on ultrasound.

Conclusions: In the presence of chronic or acute hypertension PHPT should be excluded. The determination of serum calcium should be mandatory in any patient with suspected secondary form of hypertension.

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