Authors: Anna Zsófia Puskás , Enikő Nemes-Nagy , Róbert Nemes-Nagy , Melinda Kolcsár

Abstract

Background: Parathyroid adenoma is a frequent cause of hyperparathyroidism. Its association with D hypovitaminosis can complicate this pathological state, especially in case of delayed surgical intervention. 

Case presentation: This case report presents a 77-year-old female patient with a complex medical history including dyslipidemia, hypertension, who developed primary hyperparathyroidism due to a parathyroid adenoma. The persistent hypercalcemia, elevated parathyroid hormone (PTH), and parathyroid scintigraphy led to the diagnosis, but the low 25-hydroxyvitamin D level complicated the picture. Due to personal decisions and the COVID-19 pandemic, surgery was delayed for six years, resulting in complications such as vitamin D deficiency-induced immunosuppression and osteoporosis. Post-surgical outcomes were favorable, with normalization of biochemical markers and stabilization of comorbid conditions. 

Conclusion: This case highlights that timely multidisciplinary management is essential in primary hyperthyroidism, as surgical delay worsens complications, yet parathyroidectomy can still reverse outcomes even after years of progression. 

Keywords: case report, hypercalcemia, low vitamin D status, primary hyperparathyroidism