A 55-year-old man known primary hypoparathyroidism, presented with recurrent episodes of collapses. Past Medical history of CVA, Recurrent episodes of collapse, Secondary Polycythaemia. His S Calcium ranges from 1.5 to 1.7. Not always symptomatic. Occasionally, c/o pins and needles. But having recurrent episodes of collapses with loss of consciousness. Each Episode lasts for 10 to 15 seconds. This is going on for more than 15 years. In 2013 his Calcitriol supplement was increased and eventually, he developed AKI with Hypercalcaemia. His calcium gradually came back to his baseline of 1.6 after 3 months but his kidney function took more than 2 years to come back to normal. At that time, he was under the Nephrologist. Usually, he is on Calcitriol 1.5 μg twice daily with Calcium supplements. According to the patient, he is compliant with medication. The Neurologist has also reviewed him for his recurrent collapses, but no diagnosis could be confirmed. MRI head: Established right frontal lobe and left periventricular infarcts. The patient is very reluctant to increase his Calcitriol dose as it may impair his renal function. His current blood test shows S Ca-1.7, Normal U&Es with PTH-19.9. Still having recurrent episode of collapses with LOC. He is also known to have secondary polycythemia with repeated venesection. He is under the hematologist.
Questions for the panel:: 1. Are these collapses related to Hypocalcaemia?
2. How can we get the calcium to normal level as there were an episode of AKI with hypercalcemia
3. Was the AKI related to Hypercalcemia?
16 - 18 Apr 2018
Society for Endocrinology