Bhat Shalini, Davis Susan
AACE Clin Case Rep. 2019 Jan 30;5(1):e13-e15. doi: 10.4158/ACCR-2018-0217. eCollection 2019 Jan-Feb.
Hypercalcemia in a patient with Graves disease can occur in up to 22% of cases. The mechanism is thought to be increased bone resorption. There are more rare causes of hypercalcemia in these patients with hyperthyroidism, such as hyperparathyroidism, which occurs in less than 1% of patients. We describe a rare occurrence of primary hyperparathyroidism due to multiple endocrine neoplasia type 1 (MEN 1) in a Graves disease patient presenting with hyperthyroidism and hypercalcemia.
The patient initially presented with a 3-week history of nausea, vomiting, and abdominal pain. She also had an 8-week history of a 12-pound weight loss. She was diagnosed with hyperthyroidism secondary to Graves disease and was noted to have concurrent hypercalcemia. She was diagnosed with primary hyperparathyroidism. The patient underwent subtotal thyroidectomy and total parathyroidectomy with forearm autotransplantation. Subsequent genetic testing confirmed the diagnosis of MEN 1.
A review of the literature was conducted to identify previous studies pertaining to concurrent hypercalcemia in hyperthyroid patients, focusing on reports related to their diagnosis and management.
Co-existing primary hyperparathyroidism due to MEN 1, although rare, should be considered in a patient with hyperthyroidism and hypercalcemia. A thorough evaluation is necessary to avoid a delay in the correct diagnosis and treatment of the underlying conditions. Clinicians should be aware of the rare occurrence of primary hyperparathyroidism due to MEN 1 in a Graves disease patient presenting with hyperthyroidism and hypercalcemia.
格雷夫斯病患者中高钙血症的发生率可达22%。其机制被认为是骨吸收增加。在这些甲状腺功能亢进患者中，高钙血症还有更罕见的病因，如甲状旁腺功能亢进，其发生率不到1%。我们描述了1例格雷夫斯病患者，在出现甲状腺功能亢进和高钙血症时，因1型多发性内分泌腺瘤病（MEN 1）发生了罕见的原发性甲状旁腺功能亢进。
该患者最初出现3周的恶心、呕吐和腹痛病史。她还有8周内体重减轻12磅的病史。她被诊断为格雷夫斯病继发的甲状腺功能亢进，并被发现同时存在高钙血症。她被诊断为原发性甲状旁腺功能亢进。该患者接受了甲状腺次全切除术和甲状旁腺全切除术及前臂自体移植术。随后的基因检测证实了MEN 1的诊断。
进行了文献综述，以确定先前关于甲状腺功能亢进患者并发高钙血症的研究，重点关注与其诊断和管理相关的报告。
对于甲状腺功能亢进和高钙血症患者，应考虑到因MEN 1导致的并存原发性甲状旁腺功能亢进，尽管罕见。进行全面评估对于避免潜在疾病的正确诊断和治疗延误是必要的。临床医生应意识到，在出现甲状腺功能亢进和高钙血症的格雷夫斯病患者中，因MEN 1导致原发性甲状旁腺功能亢进的情况罕见。
