Serum calcium on presentation was elevated to Prior to the workup confirming an elevated ACTH and low cortisol levels, the patient was treated with aggressive intravenous fluid repletion and calcitonin with overnight improvement in calcium to After the diagnosis of primary adrenal insufficiency was confirmed, she was treated with stress doses of intravenous hydrocortisone then gradually tapered to physiologic doses of oral hydrocortisone and fludrocortisone with resolution of her hypercalcemia by the fourth day of hospitalization.
Adrenal insufficiency is a known but uncommon cause of PTH-independent hypercalcemia, but the exact mechanism is unknown. Hypercalcemia is thought to result from a combination of a hypovolemic state seen in adrenal insufficiency which leads to decreased urinary calcium excretion as well as increased bone resorption, which may result from increased serum sclerostin concentrations. Adrenal insufficiency should be considered in the differential of PTH-independent hypercalcemia.
This case highlights the improvement in hypercalcemia that is seen with correction of glucocorticoid deficiency, and supports delaying additional work up for other PTH-independent causes until appropriate treatment has been given.
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Declaration of interest: There is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported. Funding: No specific grant from any funding agency in the public, commercial or not-for-profit sector. Browse other volumes.
Biosci Abstracts Bioscientifica Abstracts is the gateway to a series of products that provide a permanent, citable record of abstracts for biomedical and life science conferences. Searchable abstracts of presentations at key conferences in endocrinology. Endocrine Abstracts. Prev Next. Endocrine Abstracts 28 P Author affiliations. Single CRH injections failed to increase serum cortisol in any of the patients.
Glucocorticoid replacement acutely normalized serum Ca and decreased levels of carboxy-terminal telopeptide of type I collagen, a marker of bone resorption. Conclusion Adrenal insufficiency could therefore be an occult cause of hypercalcemia in anuric HD patients who are critically ill. Japanese Journal of Medicine. Already have an account? Login in here. Internal Medicine. Journal home Advance online publication Journal issue About the journal. Keywords: hypercalcemia , adrenal crisis , acute illness , bone resorption , anuria.
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