Coexistance of primary hyperparathyroidism and sarcoidosis in a hypercalcemic patient

This clinical case demonstrates difficulties in managing patients with newly diagnosed hypercalcemia. Depending on the involvement of parathyroid hormone (PTG) in the mechanisms of hypercalcemia the latter is divided into parathyroid hormone-dependent (PTH-dependent) and parathyroid hormone-independent (PTH-independent). In this clinical case an analysis of clinical, laboratory and instrumental data revealed a rare combination of PTH-dependent and PTH-independent hypercalcemia. A 74-year-old patient was diagnosed with primary hyperparathyroidism (PHPT) which was the cause of severe hypercalcemia. Persistence of hypercalcemia after surgical treatment and normalisation of PTH levels required further diagnostic search and exclusion of other causes of hypercalcemia. As a result, sarcoidosis with lesions of the mediastinal and cervical lymph nodes was revealed. Methylprednisolone was administered in the treatment regimen, which gradually normalised serum calcium levels.