SAT-764 ATYPICAL COURSE OF PRIMARY HYPERPARATHYROIDSIM: THROMBOPHLEBITIS AND TYPE 3C DIABETES MELLITUS

Abstract Disclosure: J. Kumar singh: None. S. Karale: None. G. Majidi: None. M. Bhandari: None. J. Vadodariya: None. K. Jaehoon: None. Introduction: : The most common presentation of primary hyperparathyroidism is an adenoma, causing hypercalcemia and hypophosphatemia. Common presentations include recurrent nephrolithiasis, bone pain and fatigue. Rare clinical findings make this case atypical. Case: A 27-year-old gentleman presented with complaints of acute, progressive swelling in the left hand, extending up to forearm for five days. It was associated with pain, redness, and discomfort. He also reported intermittent fever with chills for three days and progressive fatigue for three months. His appetite was reduced, while bowel and bladder movements were normal. His past medical history included Type 3C diabetes, diagnosed four months ago and chronic pancreatitis. He underwent three urinary bladder stone surgeries in the past year, the most recent being one month ago. There was no notable family history. The patient’s vitals were- blood pressure:100/70 mmHg, heart rate: 86 bpm, SpO₂: 96%, and temperature: 101°F. Random blood sugar was 215 mg/dL. Local examination of the left hand showed erythema, swelling, tenderness, and localized warmth. Systemic examinations were normal. Laboratory investigations revealed iron deficiency anemia (Hb 10.1 g/dL, low MCV, low MCH), leukocytosis (13,000/mm³) with 83% neutrophils, increased alkaline phosphatase (366 U/L) and gamma-glutamyl transferase (200 U/L). Electrolyte imbalances included hypercalcemia (11.8 mg/dL), hypophosphatemia (1.8 mg/dL), and hyponatremia (126 mEq/L). HbA1c was high (9.8%). Parathyroid hormone was elevated at 219.2 pg/mL. Doppler ultrasound of the left-hand suggested thrombophlebitis with hematoma. Abdominal ultrasound revealed a right renal calculus (10.6 mm) and a vesical calculus(14 mm), both confirmed by a non-contrast CT of the KUB region. Non-contrast abdominal CT revealed acute-on-chronic pancreatitis. The neck ultrasound showed an enlarged right inferior parathyroid gland, suggesting parathyroid adenoma. The patient was admitted and managed with IV hydration using 0.9% normal saline, IV Ibuprofen with close monitoring of biochemical and electrolyte parameters. Endocrinology was consulted for hyperparathyroidism management and surgical evaluation was requested for potential parathyroidectomy. A uro surgical referral was made for possible extracorporeal shock wave lithotripsy. Discussion: Superficial thrombophlebitis due to hypercalcemia has been described as a rare complication. Activation of clotting factors by calcium, leading to a hypercoagulable state, is the most accepted pathogenesis. Another rare complication is chronic pancreatitis that can progress into Type 3C diabetes due to the loss of pancreatic function. Presentation: Saturday, July 12, 2025