Normal Calcium, High PTH

[sdflo]

Hi,
Thank you for taking the time to read this.  I have been suffering with headache 24 hours a day, fatigue, multiple kidney stones, hypertension, that all started 2 years ago.  The kidney stones I have had 7 total, 3 in the last 1.5 years.  I have PTH of 146, Vitamin D of 25 and Calcium of 9.2.  3 endo's in my area say that it is in no way, shape, or form hyperparathyroidism but went to Mayo and the doctor says maybe but wants more proof.  They also tell me that my symptoms can not be caused by it because my calcium is normal.  They have been working on my Vitamin D to raise it and I had labs done before and PTH was 104, Vit D was 67 and Calcium 9.1.  I have to take 50,000 units 2 times a week to get my levels in the 60's but go to 20's when am on 50,000 once a week.  What do you think these labs point to?  Thank you, Stacey

[Mark Lupo, M.D.]

These calcium levels are not typical for primary hyperparathyroidism.  More typical for calcium absorption problems given the normal vit D with Ca 9.1 and PTH 104 -- what was the 24 hour urine calcium?

What type of kidney stones are these?  If doing a 24h urine, would do a "stone risk profile" to sort this out.

[Mark Lupo, M.D.]

I agree that usually symptoms of hyperparathyroidism are due to the high calcium.
Would follow-up with Dr Tiegs - I have had patients who have seen him, he is very good.

[sdflo]

I have had tests to rule out a Pheo, went off the beta blocker as my initial labs were high 1.27 for free fractionated normetanephrines.  After the beta blocker was removed it dropped below .9 so they excluded me.  Had a MRI of my adrenals and found no mass.  I am 40 years old.  I saw Dr. R D Tiegs at Mayo.  If you have any other ideas, i would appreciate them.  It has taken me 2 years of constant pushing to get this far.  My neurologist wants to call it a primary headache disorder but can not explain all the other symptoms.  They all started at the same time, coincidence?  Thanks for the reply.  

[Mark Lupo, M.D.]

This is unusual - a low Ca absorption usually is associated with lower urine calcium.
This may be an atypical primary hyperpara -- which is what Mayo may be thinking -- who did you see there?  May be worth completing the MEN evaluation to exclude pheochromocytoma given headach and hypertension.  What's your age?

[sdflo]

Thanks for your opinion Dr. Lupo.
My urine calcium is 250 mg.  I also have high alkaline phosphatase.  My stones are 70% calcium oxalate and the rest calcium phospate.  Stacey