Hi Dr. Boone, I am so grateful to have come across your website, it has brought me clarity and understanding in a subject very foreign to me. My question is, my sisters have MEN1, I have a genetic appointment in May for my testing. They all have hyperparathyroidism and have had surgery. My calcium level is 9.8 and my doctor said she corrected it due to albumin. My albumin was normal at 4.6 and my calcium was 9.8, this brought it to a 9.3. she tested my PTH at 43.7. She didn't test my vitamin D because she said she didn't feel she needed to. I have horrible bone pain too, but she said she didn't know that. She is sending me for a pituitary MRI due to high prolactin and vision problems. Why would she correct my CA if it didn't need to be corrected? Thank you so much!
Hello, I’m glad you’ve found the information on the website helpful.
Firstly, it’s important to understand that the “correction” your doctor is referring to is a mathematical adjustment based on your albumin level. Albumin is a protein in the blood that can bind to calcium, and a certain proportion of the calcium in your blood is typically bound to albumin. If your albumin level is abnormal, it can affect the total calcium level in your blood. However, in your case, since your albumin level is normal, there’s no need for a correction.
Your calcium level of 9.8 mg/dl is normal for your age. Your PTH level of 43.7 pg/ml is also within the normal range. These results indicate that at the moment, you do not have primary hyperparathyroidism. However, given that you may have MEN1, you are at risk for developing primary hyperparathyroidism in the future and should keep an eye on your calcium and PTH levels.
The high prolactin level and vision problems warrant further investigation, and an MRI of the pituitary is a reasonable next step. High prolactin can be caused by a small benign tumor in the pituitary gland (prolactinoma), which can also cause vision problems if it’s large enough to press on the optic nerves. Prolactinomas are seen in MEN1, and with your family history, make it more likely that you also have MEN1.
In summary, while your calcium and PTH levels currently do not indicate parathyroid disease, you are at high risk for developing primary hyperparathyroidism in the future. I wouldn’t recommend parathyroid surgery until you actually develop the disease. At that time, you will likely need a subtotal parathyroidectomy (typically three parathyroid glands and part of the fourth gland removed) since MEN1 causes parathyroid hyperplasia, or overgrowth of all four parathyroid glands.
