Primary hyperparathyroidism presenting as subacute encephalopathy: A case report and review of literature

Altered mental status can be a reflection of any systemic disease. Endocrinopathies such as hypercalcemia and hyperparathyroidism are among those that may present with such neurologic symptoms. The aim of this case report is to emphasize that primary hyperparathyroidism (PHPT) should be considered as a possible diagnosis in patients who present with a decline in neurological function. Case Report: Our case report details a patient with history of PHPT and breast cancer who presented with progressive neurocognitive decline, abnormal hyperkinetic involuntary movements, weight loss, and decline in functional status over the past year. Extensive workup including laboratory data, imaging, lumbar puncture, and gene panels were unremarkable. The patient underwent parathyroidectomy with improvement in her neurocognitive and functional status postoperatively. Conclusion: Parathyroidectomy has favorable outcomes when performed early in elderly patients who present with hypercalcemic encephalopathy due to primary hyperparathyroidism. Hypercalcemia and primary hyperparathyroidism should be considered in the differential diagnosis of altered mental status, especially in the elderly population. Dany Barrak1,2, MD, MPH, Romina Deldar1,2, MD, Chamilka Merle1,2, MD, Arthur Brannon III1,2, MD, Darren Jackson II1, Jennifer E Rosen2, MD Affiliations: 1Department of Surgery, MedStar Georgetown University Hospital, Washington, DC, USA; 2Department of Surgery, MedStar Washington Hospital Center, Washington, DC, USA. Corresponding Author: Jennifer E Rosen, MD, Chief, Division of Endocrine Surgery, MedStar Washington Hospital Center, 106 Irving Street Northwest, Suite 124, Washington, DC, USA; Email: Jennifer.e.rosen@medstar.net Received: 27 June 2020 Accepted: 04 August 2020 Published: 09 October 2020