Endocrine Abstracts

Introduction

Calcium is an important metabolite. Abnormal blood calcium levels can affect brain function resulting in clinical signs. Iatrogenic hypercalcemia is a disorder rarely described in literature and there are few reported cases of association with neuropsychiatric manifestations. Psychiatric symptoms and abnormal physical symptoms are usually observed with a serum calcium level above 12 mg/dl. Our case report findings suggest the importance of control of serum calcium in patients treated with active vitamin D preparations or calcium supplements.

Case report

We present a clinical case of a 64 years old woman with no significant past medical, psychiatric or substance use history. She was presented at the emergency unit with mental confusion, disorientation, headaches, significant physical weakness, difficulty moving her body, loss of appetite, nausea and vomiting, abdominal pain and constipation. These signs had started last years but were worsened the last months. Medical history: She was diagnosed with primary hypoparathyroidism 40 years ago and was treated with calcium supplements and vitamin D analogs. Last 10 years, she did not have medical control but continued the same dose of drugs by herself. Laboratory tests: calcemia 12.4 mg/dl, PTH 0.6 (8 76 pg/ml) 25OH vitamin D 10.1 ng/ml (> 30). TSH 2.3 (0.4 4.2 mIU/ml). Blood tests, liver and kidney function resulted normal. Head-CT scan resulted normal. Firstly, she was treated with liquids i/v, diuretics and oxygen therapy with discontinuation of calcium supplements and vitamin D analogs. Then she was transferred to Endocrinology Department for further treatment. After no other medical cause was found, depression due to iatrogenic hypercalcemia was diagnosed. During her hospital stay she followed psychotherapy sessions with the psychologist, onwards the psychiatrist started the treatment with antidepressants. After calcium correction, her neurological and psychiatric manifestations were improved. She discharged the hospital in improved condition, under treatment with vitamin D analogs, calcium supplements, vitamin D3, and antidepressants. One and two weeks later she resulted with normal levels of calcium and improvement of physical and mental condition. She continues to be in a stable condition, followed by endocrinologist and psychiatrist.

Conclusion

All physicians must be aware about hypercalcemia and long-term consequences especially depression and mental health, to prevent the lack of diagnosis or misdiagnosis. It is very important periodic monitoring of calcium levels in patients under treatment with calcium supplements and vitamin D.