Endocrine Abstracts

Introduction: Hypercalcemia has been described in patients with granulomatous disorders. Most commonly sarcoidosis (10% of patients) and tuberculosis with three-fold increase in hypercalciuria. It’s due to production of calcidiol from calcitriol in the lung and lymph nodes that is independent of PTH. Main modalities of therapy are low-calcium diet, glucocorticoids, and treatment of the underlying disease.The Case: A 48-year-old male, referred to end...

A 71 year old gentleman, known to have Renal Cell Carcinoma with metastasis to lung, mediastinum, spine and liver, was transferred to our services for management of T2/T3 Spinal root impingement. On admission he was noted to have severe hypercalcemia of 3.33mmol/l, mild hypophosphatemia 0.8mmol/land an ongoing acute kidney injury. He had appropriate initial management with intravenous fluids, and was started on dexamethasone 8 mg with PPI cover for the spinal metastasis. His i...

Case: We report a 79-year-old female who was referred to our Endocrine Bone Unit with osteoporosis, which was initially treated with Alendronate (but poorly tolerated due to dyspepsia) followed by annual Zoledronate infusions. Her bone history was significant for a proximal humeral fragility fracture 30-years previously. She was an ex-smoker, had limited dietary calcium intake, and had a brother with osteoporosis. DEXA demonstrated T scores at lumbar spine -1.8, total hip -2.0...

Case history: A 49-year-old male was readmitted with asymptomatic hypercalcaemia and renal impairment following a recent admission where he was diagnosed and commenced on treatment for miliary tuberculosis. He was on month 6 of standard anti-tuberculous therapy (ATT) and one month off glucocorticoids commenced for CNS-involvement. High dose cholecalciferol was started on initial admission when he was found to be normocalcaemic but vitamin-D deficient, and continued. The clinic...

Introduction: Hypercalcaemia accounts for 0.6% of all acute medical admissions1, with primary hyperparathyroidism and malignancy-associated hypercalcaemia contributing to 90% of these cases.Case Presentation: A 67-year-old female was initially seen in neurology clinic with a 3-year history of subtle word-finding difficulties, episodic confusion, and balance problems. On further probing, she reported constipation, polyuria and polydipsia, but h...

A 47-year-old female was referred and presented with generalised aches and pains and her calcium level was found to be elevated with a corresponding raised PTH level. She had previously had a parathyroid hormone level in excess of 212.000 pmol/l(The upper limit for our assay is 212 pmol/l). Interestingly, she has had a mildly elevated calcium level in 2017, rechecked in 2018 and lost to follow up until December 2021. At this juncture, she sustained a closed fracture of her met...

Introduction: Familial hypocalciuric hypercalcaemia (FHH) is an autosomal dominant disorder affecting the calcium-sensing receptor (CaSR) expressed in the chief cells of the parathyroid glands and in the renal tubules. The CaSR permits the parathyroid gland to sense variations in serum calcium thus regulating parathyroid hormone (PTH) secretion; it also regulates calcium excretion in the kidneys. In FHH, loss-of-function mutations in the CaSR result in a higher serum calcium d...

Background: Hypercalcaemia is a commonly encountered electrolyte abnormality within the acute medical take; identification of the underlying aetiology can guide optimised care.Case : A 23 year old male patient with a background of insulin dependent diabetes, diabetic nephropathy (chronic kidney disease stage 1) was admitted feeling acutely unwell. Clinical and bed side investigations identified he was in severe diabetes ketoacidosis. His condition prompt...

A 30-year-old lady was initially seen in our clinic with a slight elevated corrected calcium with an elevated parathyroid hormone in March 2021. The elevated calcium [2.58mmol/l(NR: 2.10-2.55)] was first noted in 2018 when she had investigations for easy bruising, fatigue, breathlessness, and weight loss. The symptoms settled on their own and her calcium levels were monitored routinely. She was referred to our clinic when the corrected calcium had increased to 2.69mmol/lwith a...

A 66 year old woman was referred to endocrinology in January 2023 with severe hypercalcaemia of 4.7mmol/ladjusted (2.2-2.6mmol/l) and low normal PTH of 1.8 pmol/l(1.6-6.9 pmol/l). She presented with one week of cough, breathlessness and fatigue, and 3-4 days of nausea and vomiting. She had commenced Furosemide 40 mg for bloating symptoms one month prior. She had a history of breast cancer treated with mastectomy and lymph node clearance in 2019, with subsequent Letrozole (ongo...

Introduction: Primary hyperparathyroidism is usually caused by a parathyroid adenoma (80-85%), occasionally by primary parathyroid hyperplasia (10-15%), and rarely by atypical parathyroid tumor (APT) or carcinoma (<1%). APT reflects parathyroid neoplasm of uncertain malignant potential which poses a challenge for differential diagnosis with parathyroid carcinomas. Most patients exhibit strong symptomatology of hypercalcemia at presentation shared with the benign causes of ...

A 37 year old woman presented to A&E with symptoms of hyperemesis gravidarum. She was 9 weeks pregnant, in her third pregnancy. It was noted that her calcium level was 3.13mmol/l, PTH 12.1 pmol/l, vitamin D 42nmol/l. She was treated with IV fluids and discharged with endocrine follow up. The endocrine and obstretric teams arranged for an urgent review on the antenatal ward the next week. Calcium was still raised at 3mmol/l. She was admitted overnight for antiemetics and IV...