Mrs Lynette Murray (knuth)1
1Health Nz Taranaki, New Plymouth, New Zealand
Biography:
I am an experienced renal clinician with nearly two decades of dedicated practice. I began working in Taranaki Base Hospitals renal service in 2006, where I have gained comprehensive experience across all areas or dialysis, transplant and CKD. In 2020 I advanced my practice and qualified as a Nurse Practitioner with a focus on CKD, Transplant and Haemodialysis
Abstract:
Background:
Declining kidney function in the context of hypercalcaemia and elevated parathyroid hormone often prompts referral for specialist assessment and is frequently managed initially in an outpatient setting. While such presentations may appear straightforward, delays in diagnosis and definitive management can result in significant morbidity.
Case Presentation:
We present the case of Mrs T, a 76-year-old European woman with no prior history of kidney disease or diabetes and a background of stage 1 hypertension, who was referred for evaluation of deteriorating renal function. Initial investigations revealed marked hypercalcaemia (calcium 3.0 mmol/L) and significantly elevated parathyroid hormone levels (PTH 25 pmol/L), consistent with primary hyperparathyroidism.
Clinical Course:
This case study follows the patient’s pathway through diagnostic delays, imaging, and surgical follow-up. During this period, she experienced adverse effects from cinacalcet, a recently introduced medical therapy. Her condition progressed to a life-threatening intraoperative event, compounded by the cumulative systemic effects of prolonged, untreated primary hyperparathyroidism.
Conclusion:
This case highlights how an apparently routine referral can evolve into a complex and life-threatening clinical scenario. It underscores the importance of early recognition, timely investigation, and prompt surgical intervention in primary hyperparathyroidism to prevent serious complications, preserve renal function, and improve overall patient outcomes.