Objective:

To present a case of a patient with primary hyperparathyroidism (PHPT) exhibiting rare electrolyte abnormalities and to consider Gitelman syndrome as a possible underlying condition.

Approach:

Key Findings:

• The patient exhibited severe hypercalcemia (4.18 mmol/L), hypophosphatemia, hypokalemia (2.5 mmol/L), and hypomagnesemia (0.23 mmol/L).
• Urine analysis revealed renal potassium and magnesium wasting and severe hypocalciuria (calcium-to-creatinine clearance ratio, 0.0093) despite hyperparathyroidism.
• Vitamin D deficiency was also present, with a level of 14.2 ng/mL, complicating the clinical picture.

Interpretation:

Persistent hypokalemia, hypomagnesemia, and unexpected hypocalciuria in patients with PHPT may suggest the presence of concurrent renal tubulopathies.

Limitations:

• Resource limitations prevented advanced imaging techniques like 4D-CT or Sestamibi uptake scan.

Conclusion:

This case highlights the need for clinicians to consider renal tubulopathies in patients with PHPT presenting with unusual electrolyte disturbances.

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