Endocrine Abstracts (2019) 63 P516 | DOI: 10.1530/endoabs.63.P516

Immobilization induced hypercalcemia

Derya Köseoğlu & Nafiye Helvacı

Çorum Erol Olçok Education and Reserach Hospital, Çorum, Turkey.

Introduction: Immobilization induced hypercalcemia, which was first described in 1941 by Albright, is an uncommon reason for hypercalcemia. It is associated with increased bone remodeling disorders and conditions associated with limited movement such as medullar lesions or vascular events. The exact mechanism of the disorder is unknown. Diagnosis requires an detailed evaluation to rule out other causes of hypercalcemia.

Case presentation: A 24 year old man was admitted to our hospital after a severe traumatic brain injury related to a car crush. Following the initial treatment of his injury, he remained in a chronic immobilization state and after seven months in intensive care unit he presented with hypercalcemia. On laboratory analyses; elevated ionized and total calcium levels with decreased PTHi levels were detected (table 1). Thyroid and adrenal gland functions were normal. He had no past medical history and he did not use any drugs which could cause hypercalcemia. For this reasons immobilization induced hypercalcemia were considered as the diagnosis. Initial therapy including fluid and diuretic therapy was administered. Although these therapy, there was no remarkable decrease on the levels of total calcium, and an infusion of 4 mg zoledronic acid was added to his treatment. Three weeks after zoledronic acid therapy, serum calcium levels increased and repeated administration of zoledronic acid was needed. Because mobilization of the patient is still not possible, intermittent zoledronic acid is needed currently.

Table 1 The laboratory values of the patient.
ValuesResultsReference value
Total Calcium13.4 mg/dl8.6–10.2
Albumin19 g/l35–51
Corrected Calcium15.08 mg/dl8.6–10.2
Phosphorus2.4 mg/dl2.5–4.5
Creatinine1.3 mg/dl0.6–1.3
Parathyroid hormone9.3 pg/ml18.5–88
25-hidroxi vitamin D17.7 ng/ml>30

Conclusion: Immobilization induces hypercalcemia is an uncommon disorder. This rare condition should be kept in mind in immobilized patients with hypercalcemia, especially in patients who are followed in intensive care units.

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