A 30-year old woman presents to the emergency department with acute abdominal pain that is colicky in nature. She has hematuria and bone pain. Physical examination reveals her to be dehydrated. Plain X- ray of the abdomen reveals a radiopaque renal calculus on the right side. Serum calcium is found to be elevated. The patient’s past medical history is significant for an islet cell tumor of the pancreas( insulinoma). What is the most likely diagnosis?
Answer: Primary hyperparathyroidism caused by an adenoma. Reason for dehydration- primary hyperparathyroidism results in hypercalcemia. This causes impairment of the action of antidiuretic hormone( ADH) at the collecting ducts. This is an example of Nephrogenic Diabetes insipidus. These patients are expected to have polyuria and may become dehydrated, especially if water intake is not maintained.
Most likely syndrome is Multiple endocrine neoplasia ( MEN) type 1
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