ESPE Abstracts

Introduction: We report a case of a 15 year old male with metabolic syndrome due to primary hyperparathyroidism.

Case report: A 15 year old male was admitted in our department for the evaluation and management of obesity. His medical history revealed a progressive weight gain in the last 3 years in an emotional familial context. Clinical features: Obesity: Z-score of +2.32 DS, a height of 1.80 m and a weight of 108 kg, with a BMI of 33.33 kg/m² at the 99th centile, with a round facies with erythema, abdominal obesity with red striae, a BP of 180/100 mmHg and a HR of 78/min, Tanner stage P5G5. Laboratory: Extensive investigations for secondary hypertension were initiated, which excluded hypercortisolism, hyperaldosteronism, pheochromocytoma, hyperthyroidism and reno-vascular hypertension. The routine blood tests (the blood glucose, the low HDL cholesterol, the insulinemia and HbA1c) together with the high blood pressure and waist circumference over the 90th centile confirmed the IDF based criteria for metabolic syndrome. In an adult patient the diagnosis of metabolic syndrome is a sufficient reason for high blood pressure but taking into account the patient’s age we continued the etiological investigation. A secondary cause of hypertension was confirmed as a primary hyperparathyroidism was diagnosed by a high calcium level of 12.2 mg/dl, a high PTH of 166 pg/ml and a low 25OHvitamine D of 20.1 ng/dl. Moreover a parathyroid adenoma was diagnosed at the neck ultrasound. We normalized the calcaemia and the patient was referred to surgery due to the high calcium values and the apparition of complications- hypertension, with the normalization of the calcium, PTH and BP levels in postop.

Conclusion: The favorable outcome after surgery confirmed not only the diagnosis of primary hyperparathyroidism but also the link between the metabolic syndrome, high blood pressure and this condition, with high cardiovascular morbidity and mortality.