Renal Papillary Necrosis Associated With Normocalcemic Primary Hyperparathyroidism

Ismail C. Ebrahim, Gregory Schmidt, Tanner A. Slayden, Thanh D. Hoang*, Mohamed K.M. Shakir

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Objectives: Renal papillary necrosis (RPN) occurring in primary hyperparathyroidism (PHPT) has not been reported. We present a 50-year-old woman who manifested RPN associated with hypercalciuria and normocalcemic PHPT. Methods: The diagnosis of RPN was based on imaging studies (ultrasound and computed tomography [CT] scan). PHPT was diagnosed with high parathyroid hormone (PTH) and high/normal serum calcium. Results: A 38-year-old woman was evaluated for hypercalcemia (serum calcium, 11.8 mg/dL; ionized calcium, 6.3 mg/dL; phosphorus, 1.8 mg/dL; intact PTH, 98 pg/mL; and 24-hour urine calcium, 543 mg). Renal ultrasound showed no nephrocalcinosis or nephrolithiasis. A parathyroid scan revealed a left parathyroid adenoma. The patient underwent parathyroidectomy, and she became normocalcemic with normal serum PTH levels postoperatively. One year later, she was diagnosed with a left-sided bronchial carcinoid tumor. Following surgery, a surveillance gallium68 positron emission tomography/CT scan performed 2 years later was negative for metastases. Twelve years later (aged 50 years), she presented for follow-up and reported no symptoms of hypercalcemia, fractures, nephrolithiasis, history of pyelonephritis, diabetes mellitus, analgesic drug use, or hypertension. Her serum calcium level was 9.1 mg/dL, PTH level was 82 pg/mL, 25-OH vitamin D level was 34 ng/mL, and 24-hour urine calcium level was 410 mg. However, renal ultrasound showed bilateral RPN that was confirmed by a CT scan. Conclusion: RPN may be associated with hypercalciuria and normocalcemic PHPT. Additional studies with a large number of patients are needed.

Original languageEnglish
Pages (from-to)113-116
Number of pages4
JournalAACE Clinical Case Reports
Issue number2
StatePublished - 1 Mar 2021
Externally publishedYes


  • MEN
  • hypercalciuria
  • normocalcemic hyperparathyroidism
  • renal papillary necrosis


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