Sub-acute physical and mental decline associated with abnormally hypercalcemia: the case report of an oldest-old woman saved by surgery
2019
Background: the case of an oldest-old woman with severe hypercalcemia and hyperparathyroidism due to
left parathyroid adenoma.
Case presentation: An 85-year-old woman, hospitalized for rapid loss of functional abilities, mental
confusion, worsening of depression, anorexia and incontinence. In the medical history, she had depression,
hypertension, osteopenia and osteoarthritis. Blood examinations showed high levels of calcium and intact
parathyroid hormone (PTHi), severe renal failure with hyperphosphoremia. After hydration and loop
diuretic administration, renal function improved and pamidronate and calcimimetic treatments were
followed by reduction of calcium levels. The ultrasound of neck identified a possible parathyroid adenoma;
99Tc-sestamibi scintigraphy and CT scan with contrast confirmed the diagnosis. The surgical left
hemithyroidectomy was the treatment of choice and the PTHi and calcium reached normal circulating levels
immediately post-surgery. At the 3-month clinical follow-up from surgery, the functional, psychological
and cognitive functions improved substantially, although mood disorder secondary to disability persisted.
Conclusions: Hypercalcemia due to primary hyperparathyroidism is a low prevalence condition among
older adults. However, we should keep in mind whenever we find ourselves facing a sudden and unjustified
physical, psychological and cognitive deterioration in such a clinical condition old and oldest-old persons.
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