{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T04:53:12Z","timestamp":1781844792907,"version":"3.54.5"},"reference-count":19,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T00:00:00Z","timestamp":1781827200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Primary hyperparathyroidism (PHPT) is commonly associated with hypercalcemia, hypophosphatemia, and hypercalciuria. Hypokalemia and hypomagnesemia are rare and indicate a complicated etiology.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>We describe a 74-year-old woman who presented with metabolic encephalopathy and moderate dehydration. Biochemical examinations revealed a parathyroid crisis with severe hypercalcemia (4.18 mmol\/L), hypophosphatemia, hypokalemic (2.5 mmol\/L) metabolic alkalosis, severe hypomagnesemia (0.23 mmol\/L), and a high level of intact parathyroid hormone (243.0 pg\/mL). The electrolyte imbalances were resistant to proper hydration and electrolyte replacement. Markedly, urine analysis showed renal potassium and magnesium wasting and severe hypocalciuria (calcium-to-creatinine clearance ratio, 0.0093). The presence of this paradoxical hypocalciuria despite PHPT brought into question the possibility of an underlying renal tubulopathy or accompanying vitamin D deficiency. Vitamin D assay showed deficiency with a level of 14.2 ng\/mL. Ultrasound neck and contrast-enhanced computed tomography of the neck showed a right thyroid lesion for which the patient underwent right hemithyroidectomy and parathyroidectomy. Histopathological examination revealed a parathyroid adenoma. Although the patient\u2019s hypercalcemia settled postoperatively, hypomagnesemia persisted despite vitamin D supplementation, which indicates the presence of underlying renal tubulopathy, likely Gitelman syndrome.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This case emphasizes that persistent hypokalemia, hypomagnesemia, and unexpected hypocalciuria in patients with PHPT should prompt clinicians to suspect concurrent renal tubulopathies such as Gitelman syndrome.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fendo.2026.1829964","type":"journal-article","created":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T04:29:23Z","timestamp":1781843363000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: Unusual electrolyte changes in primary hyperparathyroidism\u2014a call to suspect underlying Gitelman syndrome"],"prefix":"10.3389","volume":"17","author":[{"given":"Dasili Wickramasinghe Aruna","family":"Shantha","sequence":"first","affiliation":[{"name":"Department of Medicine, Faculty of Medicine, University of Peradeniya","place":["Peradeniya, Sri Lanka"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sasmitha Ravindu","family":"Waidyatilleke","sequence":"additional","affiliation":[{"name":"Department of Medicine, Faculty of Medicine, University of Peradeniya","place":["Peradeniya, Sri Lanka"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kanishka Piumi","family":"Senevirathne","sequence":"additional","affiliation":[{"name":"Department of Medicine, Faculty of Medicine, University of Peradeniya","place":["Peradeniya, Sri Lanka"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ravindran","family":"Dhanushkar","sequence":"additional","affiliation":[{"name":"Department of Surgery, Faculty of Medicine, University of Peradeniya","place":["Peradeniya, Sri Lanka"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kushalee Poornima","family":"Jayawickreme","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Teaching Hospital","place":["Peradeniya, Sri Lanka"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Buddika K.","family":"Dassanayake","sequence":"additional","affiliation":[{"name":"Department of Surgery, Faculty of Medicine, University of Peradeniya","place":["Peradeniya, Sri Lanka"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chamara","family":"Dalugama","sequence":"additional","affiliation":[{"name":"Department of Medicine, Faculty of Medicine, University of Peradeniya","place":["Peradeniya, Sri Lanka"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manoji","family":"Pathirage","sequence":"additional","affiliation":[{"name":"Department of Medicine, Faculty of Medicine, University of 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