Rajan Remya, Paul Immanuel, Cherian Kripa Elizabeth, Korula Anu, Hephzibah Julie, Manipadam Marie Therese, Abraham Deepak Thomas, Kapoor Nitin, Paul Thomas Vizhalil
Department of Endocrinology, Diabetes and Metabolism, Christian Medical College and Hospital, Vellore, India.
Department of Pathology, Christian Medical College and Hospital, Vellore, India.
AACE Clin Case Rep. 2020 Dec 28;7(1):69-71. doi: 10.1016/j.aace.2020.11.018. eCollection 2021 Jan-Feb.
Primary hyperparathyroidism (PHPT) has varied clinical presentations. Hematologic abnormalities secondary to PHPT have been described before. However, pancytopenia as the initial presentation has rarely been reported. We report a patient with PHPT who presented for evaluation of pancytopenia.
Histopathology of the bone marrow at presentation is described. Bone biochemistry results and the hematologic profile before and after curative parathyroidectomy are presented.
A 48-year-old woman presented with pancytopenia (hemoglobin, 6.3 g/dL; total leucocyte count, 3000 cells/mm; and platelet count, 60 000 cells/mm), and her bone marrow study showed marrow fibrosis. Biochemical evaluation revealed hypercalcemia (15.5 mg/dL), hypophosphatemia (2.2 mg/dL), and elevated total alkaline phosphatase (4132 U/L). Bone mineral density assessment by dual-energy X-ray absorptiometry scan revealed osteoporosis at all 3 sites, which was more severe in the distal one third of the forearm. Further investigations confirmed the diagnosis of PHPT (serum parathyroid hormone, 2082 pg/mL). Following curative parathyroidectomy, in addition to normalization of calcium, there was restoration of all 3 hematologic cell lines at 3 months.
Pancytopenia may be a rare manifestation of PHPT. Thus, it may be prudent to evaluate the calcium profile in patients with chronic refractory anemia and pancytopenia.
原发性甲状旁腺功能亢进症（PHPT）有多种临床表现。此前已有关于PHPT继发血液学异常的描述。然而，以全血细胞减少作为首发表现的情况鲜有报道。我们报告一例以全血细胞减少前来评估的PHPT患者。
描述了就诊时骨髓的组织病理学情况。呈现了甲状旁腺切除治愈前后的骨生化结果及血液学指标。
一名48岁女性出现全血细胞减少（血红蛋白6.3 g/dL；白细胞总数3000个/mm；血小板计数60000个/mm），其骨髓检查显示骨髓纤维化。生化评估显示高钙血症（15.5 mg/dL）、低磷血症（2.2 mg/dL）及总碱性磷酸酶升高（4132 U/L）。通过双能X线吸收法扫描进行的骨密度评估显示所有三个部位均存在骨质疏松，在前臂远端三分之一处更为严重。进一步检查确诊为PHPT（血清甲状旁腺激素2082 pg/mL）。甲状旁腺切除治愈后，除了血钙恢复正常外，三个月时所有三种血细胞系均恢复正常。
全血细胞减少可能是PHPT的一种罕见表现。因此，对于患有慢性难治性贫血和全血细胞减少的患者，评估血钙情况可能是谨慎之举。
