Case Report: Unusual electrolyte changes in primary hyperparathyroidism—a call to suspect underlying Gitelman syndrome

Background Primary hyperparathyroidism (PHPT) is commonly associated with hypercalcemia, hypophosphatemia, and hypercalciuria. Hypokalemia and hypomagnesemia are rare and indicate a complicated etiology. Case presentation 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 hypomagne