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During the congress, E-Posters will be accessible to all participants on the congress website 24/7, as well as in the E-poster stations in the congress center.
Preparing your E-Poster
Please review the E-Poster format requirements carefully when preparing your E-Poster. Should your E-Poster not meet the mentioned requirements, it may not be displayed as described above.
E-Poster Submission Deadline
Please prepare and upload your E-Poster no later than March 14, 2026 11.59PM CET. After this date, you will no longer be able to prepare and upload your E-poster and it will not be displayed and accessible on the congress website.
Please follow the instructions below to input your abstract title.
Abstract titles should be brief and reflect the content of the abstract.
A 53-year-old woman presented to a nearby clinic with nausea, dizziness, headache, and loss of appetite that had begun three days earlier. Blood samples were obtained, and the next day, the results showed a serum creatinine level of 2.60 mg/dL, serum calcium of 19.1 mg/dL, and serum uric acid of 12.8 mg/dL. She was therefore referred to our hospital and admitted the same day (hospital day 1).
On admission, her blood pressure was 158/82 mmHg, heart rate 115 beats per minute, oxygen saturation 97% on room air, and respiratory rate 22 breaths per minute. The remainder of the physical examination was unremarkable, with no neuromuscular abnormalities. Chest radiography and electrocardiography showed no significant findings. Ultrasonography revealed no dilation of the renal pelvis but demonstrated a collapsed inferior vena cava.
At that time, she was diagnosed with hypercalcemia, acute kidney injury, and hypovolemia. To reduce her serum calcium level, hemodialysis (HD) was initiated using a dialysate containing calcium at 2.5 mEq/L. After the first HD session, her serum calcium decreased to 12.3 mg/dL but rose again to 17.2 mg/dL on the morning of hospital day 2, prompting a second HD session.
On hospital day 3, the intact parathyroid hormone (iPTH) level was found to be 1650 pg/mL. Treatment with both zoledronic acid (4 mg intravenously) and the calcimimetic agent evocalcet (1 mg/day) was started to control severe, refractory hypercalcemia. Thereafter, her serum calcium level rapidly decreased to 9.5 mg/dL by hospital day 6 and remained within the normal range until surgery.
Other laboratory results were as follows: PTH-related peptide <1.0 pmol/L, 1,25-dihydroxyvitamin D 39.2 pg/mL, 25-hydroxyvitamin D 9.9 ng/mL, ACE 9.7 U/L, bone-specific alkaline phosphatase 30.9 μg/L, tartrate-resistant acid phosphatase 5b 1440 mU/dL, and type I procollagen 395 ng/mL.
Contrast-enhanced computed tomography revealed an enlarged right inferior parathyroid gland measuring 24 mm in diameter, without evidence of invasion. On hospital day 6, 99mTc-MIBI scintigraphy demonstrated marked tracer uptake corresponding to the right inferior parathyroid gland, with no ectopic accumulation. On hospital day 9, the enlarged right inferior parathyroid gland was successfully resected, and the serum iPTH level decreased to 42 pg/mL on hospital day 10.
Her serum calcium was maintained within the normal range, initially with intravenous alfacalcidol and subsequently with oral alfacalcidol and calcium lactate. She was discharged on hospital day 21.
What was most remarkable about this case was that, on the morning of surgery, the serum iPTH level had further increased to 3880 pg/mL despite evocalcet treatment, which is indicated for primary hyperparathyroidism. The negative feedback mechanism via the calcium-sensing receptor was presumed to have failed, and only the bisphosphonate therapy proved effective.
In conclusion, in cases of extreme and refractory hypercalcemia due to markedly elevated iPTH, there may be instances in which calcimimetics are ineffective, whereas bisphosphonate therapy alone is highly effective.
