{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T14:47:57Z","timestamp":1781880477145,"version":"3.54.5"},"reference-count":18,"publisher":"SAGE Publications","issue":"12","license":[{"start":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T00:00:00Z","timestamp":1764547200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T00:00:00Z","timestamp":1764547200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Int Med Res"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:p>Primary hyperparathyroidism is characterized by hypercalcemia and hypophosphatemia caused by excessive parathyroid hormone secretion. Gitelman syndrome, a rare autosomal recessive salt-losing tubulopathy, presents with hypokalemia, hypomagnesemia, hypocalciuria, and secondary hyperaldosteronism. The coexistence of these conditions leads to an atypical clinical picture and may result in a refractory hypercalcemic crisis that responds poorly to standard therapies. We describe a case of refractory hypercalcemia accompanied by hypophosphatemia, elevated parathyroid hormone levels, hypokalemia, hypomagnesemia, and, notably, hypocalciuria that was inconsistent with the degree of hypercalcemia. The patient experienced recurrent hypercalcemic crises that required treatment with zoledronic acid and denosumab after conventional interventions failed. The diagnosis was ultimately confirmed through postoperative pathology and genetic testing. This case emphasizes that hypocalciuria in the setting of persistent hypercalcemia\u2014especially when severe hypomagnesemia is present\u2014should raise suspicion for underlying Gitelman syndrome. Early identification of this coexistence is essential, as optimal management requires surgical treatment of primary hyperparathyroidism followed by targeted correction of electrolyte abnormalities associated with Gitelman syndrome, ultimately improving clinical outcomes.<\/jats:p>","DOI":"10.1177\/03000605251403280","type":"journal-article","created":{"date-parts":[[2025,12,10]],"date-time":"2025-12-10T00:13:42Z","timestamp":1765325622000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Refractory hypercalcemic crisis: A case of primary hyperparathyroidism with Gitelman syndrome"],"prefix":"10.1177","volume":"53","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-7585-4043","authenticated-orcid":false,"given":"Menghua","family":"Yuan","sequence":"first","affiliation":[{"name":"Tianjin Medical University General Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Baoping","family":"Wang","sequence":"additional","affiliation":[{"name":"Tianjin Medical University General Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yaxin","family":"Liu","sequence":"additional","affiliation":[{"name":"Tianjin Medical University General Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chonggui","family":"Zhu","sequence":"additional","affiliation":[{"name":"Tianjin Medical University General Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tong","family":"Liu","sequence":"additional","affiliation":[{"name":"Tianjin Medical University General Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qing","family":"He","sequence":"additional","affiliation":[{"name":"Tianjin Medical University General Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ming","family":"Liu","sequence":"additional","affiliation":[{"name":"Tianjin Medical University General Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,12,9]]},"reference":[{"key":"e_1_3_8_2_2","first-page":"221","article-title":"A new familial disorder characterized by hypokalemia and hypomagnesemia","volume":"79","author":"Gitelman HJ","year":"1966","unstructured":"Gitelman HJ, Graham JB, Welt LG. A new familial disorder characterized by hypokalemia and hypomagnesemia. Trans Assoc Am Physicians 1966; 79: 221\u2013235.","journal-title":"Trans Assoc Am Physicians"},{"key":"e_1_3_8_3_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199904153401507"},{"key":"e_1_3_8_4_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-021-95521-6"},{"key":"e_1_3_8_5_2","doi-asserted-by":"publisher","DOI":"10.1093\/qjmed\/hcq123"},{"key":"e_1_3_8_6_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2265.2002.01223.x"},{"key":"e_1_3_8_7_2","first-page":"155","article-title":"A case of Gitelman syndrome with asymptomatic primary hyperparathyroidism","volume":"17","author":"Chen J","year":"2024","unstructured":"Chen J, Yu XH, Wang XL, et\u00a0al. A case of Gitelman syndrome with asymptomatic primary hyperparathyroidism. Chin J Osteoporos Bone Miner RES 2024; 17: 155\u2013160.","journal-title":"Chin J Osteoporos Bone Miner RES"},{"key":"e_1_3_8_8_2","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000039447"},{"key":"e_1_3_8_9_2","first-page":"1098222","article-title":"A case of Gitelman syndrome with hypercalcemia secondary to primary hyperparathyroidism","volume":"2022","author":"Alnahas Z","year":"2022","unstructured":"Alnahas Z, Markov M, Horani MH. A case of Gitelman syndrome with hypercalcemia secondary to primary hyperparathyroidism. Case Rep Endocrinol 2022; 2022: 1098222.","journal-title":"Case Rep Endocrinol"},{"key":"e_1_3_8_10_2","doi-asserted-by":"publisher","DOI":"10.1136\/bcr-2017-223663"},{"key":"e_1_3_8_11_2","first-page":"241","article-title":"An unusual case of Gitelman's syndrome with hypercalcemia","volume":"34","author":"Wen YK.","year":"2012","unstructured":"Wen YK. An unusual case of Gitelman's syndrome with hypercalcemia. Ren Fail 2012; 34: 241\u2013243.","journal-title":"Ren Fail"},{"key":"e_1_3_8_12_2","doi-asserted-by":"publisher","DOI":"10.1111\/head.12246"},{"key":"e_1_3_8_13_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00259-021-05334-y"},{"key":"e_1_3_8_14_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12902-021-00838-y"},{"key":"e_1_3_8_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.suc.2019.04.006"},{"key":"e_1_3_8_16_2","doi-asserted-by":"publisher","DOI":"10.3390\/jcm12216718"},{"key":"e_1_3_8_17_2","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2022.881225"},{"key":"e_1_3_8_18_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2022.15396"},{"key":"e_1_3_8_19_2","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000005691"}],"container-title":["Journal of International Medical Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/03000605251403280","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/03000605251403280","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/03000605251403280","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T10:46:50Z","timestamp":1777459610000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/03000605251403280"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12]]},"references-count":18,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2025,12]]}},"alternative-id":["10.1177\/03000605251403280"],"URL":"https:\/\/doi.org\/10.1177\/03000605251403280","relation":{},"ISSN":["0300-0605","1473-2300"],"issn-type":[{"value":"0300-0605","type":"print"},{"value":"1473-2300","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12]]},"article-number":"03000605251403280"}}