Can Diabetes Associated With Hyperparathyroidism Be an Additional Indication for Parathyroidectomy? A Case Report

Primary hyperparathyroidism is not uncommon. It has varied presentations ranging from asymp-tomatic disease to the classic “stones, groans, moans”. This is a case report of a 49 year-old woman, who presented with sensory obtunda-tion, abdominal pain, associated with vomiting and denovo detected diabetes mellitus. She had a past history of bilateral nephrolithiasis, and was found to have hypercalcemia (serum corrected calcium 12.8 mg/dL) with elevated serum intact parathormone (183 pg/mL, normal range 13-54 pg/mL). The 99m-Tc MIBI scintigraphy localized the source of parathormone to the right inferior parathyroid gland. Being dehydrated, she was treated with saline diuresis, salmon calcitonin and intravenous pamidronate. Her blood sugar was reported to be 421 mg/dL, and the glycemia was controlled with insulin therapy. A 2 X 2 cm sized right inferior parathyroid adenoma was later removed. The glycemic status improved dramatically after parathyroidectomy and the patient was euglycemic on low doses of glimepiride. This case study suggests that pri-mary hyperparathyroidism might also contribute to hyperglycemia in subjects with diabetes mel-litus.