International Journal of Clinical Case Reports 2015, Vol.5, No. 39, 1-3
3
Figure 2 USG(a) and CT scan(b) of neck
Discussion
Normocalcaemic Primary hyperparathyroidism was
first recognized in 2008 (Bilezikian et al., 2009).
Prevalance of Primary hyperparathyroidism varies
from 0.5% to 16.7% in various series. (Charopoulas et
al., 2006). Whether there is masking of hypercalcaemia
due to presence of renal failure it is unknown. Again
why the biphasic nature of nomocalcaemic primary
hyperparathyroidism doesn’t change in presence of
chronic kidney disease is also unknown. Our patient
has reduced GFR (43 ml/min/1.73 m
2
BSA) with
increased parameters of bone resorption. It is essential
to screen such a patient from apparently normal
population (Bilezekian et al., 2010). In conclusion it is
appeared that even in a patient with nephrocalcinosis,
renal failure and normocalcaemia, Primary hyperpara-
thyroidism should be evaluated as early as possible.
Author’s contribution
PKD: designed and managed the patient
NJ: took the history and collected all the investigations
PKD & AHMTM: finalized and drafted the article
All authors read and approved final manuscript.
Acknowledgement
We pay our thanks to the patient and our humble gratitude to
the director of Chittagong Medical College Hospital for giving
us the opportunity to report this case.
References
Bilezikian J.P., Khan A.A., and Potts Jr., 2009, Guidelines for the
management of Primary hyperparathyroidism: summary statement
from the third international workshop, The Journal of Clinical
Endocrinology and Metabolism, 94: 335-339
Bilezekian J.P., and Silverberg S.J., 2010, Normocalcaemic Primary
hyperparathyroidism, Arq Bras EndocrinolMetab, 54: 106-109
Charopoulas I., Tournis S., Trovas G., Raptou P., Kalrymides P., Skrandavos
G., Katnalira K., and Lyritin G.P., 2006, Effect of primary hyperparathyroidism
on volumetric bone mineral density & bone geometry assessed by
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The Journal of Clinical Endocrinology and Metabolism, 91: 1748-1753
Cusano N.E., Silverberg S.J., and John P. Bilezikian, 2013, Normocalcaemic
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Rao D.S., Wilson R.J., Kleerekoper M., and Parfitt A.M., 1988, Lack of
biochemical progression or continuation of accelerated bone loss in
mild asymptomatic primary hyperparathyroidism: evidence for biphasic
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