Experimental Biology 2010: Primary Hyperparathyroidism: A Potentialy Treatable Medical Cause Of Progression Of Aortic Stenosis. A Case Report.

Purpose of Study: A case report and discussion to highlight the early diagnosis of primary hyperparathyroidism in patients with Aortic Stenosis

Methods Used: Case study and review of current literature

Summary of Results: 65 year old male presented to the hospital for evaluation of surgery for aortic stenosis. He was diagnosed with aortic stenosis 4 years ago after having an angiogram and echo for evaluation of coronary artery disease. His echocardiogram at that time suggested mild aortic stenosis. He subsequently had a repeat echo 4 years after the initial echo which showed severe aortic stenosis with a gradients of 137/83 mmHg.(peak/mean)

Echo findings:
1. Normal Lv size and function. LVEF=55%. Severe LVH
2. Severe aortic stenosis by 2D appearance and aortic valve pressure gradients, Pk/Mn gradient of 137/83 mmHg. AVA 0.7 cm2.
4. Dilated ascending aorta 4.5cm.
5. Moderate posterior mitral annular calcification.
Angiogram was essentially normal.

Routine pre operative labs also showed calcium level of 11.7(normal 8.5 to 10.5), were otherwise normal. His serum cholesterol was 93 and LDL was 49.

Hospital Course:
Patient underwent surgery consisting of aortic valve replacement with #23 Trifecta valve aortoplasty. Post operatively the calcium level ranged from 9.5 to 10.5. However given the rapid progression of his aortic stenosis and calcification noted on the mitral valve, a parathyroid hormone level (pTH) was sent for evaluation of hyperparathyroidism, this was found to be elevated at 169 pg/ml (normal levels 10-60), a 24 urinary calcium level was 854 mg (normal 10-300) excluding familial hypocalciuric hypercalcemia. The patient was diagnosed with primary hyperparathyroidism and referred to endocrinology for further evaluation.

Conclusions: Primary hyperparathyroidism if detected and treated early can potentially prevent progression of aortic stenosis