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JRPMS Vol 3, No 2, June 2019, p.67-70

doi: 10.22540/JRPMS-03-067

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Case Report

Hypercalcaemia in an idiopathic hypoparathyroidism patient, due to sarcoidosis

Irena Karabella, Maria Meliou

  • Department of Internal Medicine, “Sotiria” General Hospital of Diseases of the Thorax, Athens, Greece

Keywords: Hypercalcaemia, Idiopathic hypoparathyroidism, 1.25(OH)2D3, Sarcoidosis


Abstract

We report the case of a female 68 years old patient who appeared in the emergency department (ED) with severe weakness, vomiting and mild confusion with onset 5 days before admission. Previous medical history consisted of idiopathic hypoparathyroidism, diabetes mellitus, hypertension, chronic renal disease and an ischemic stroke. She was previously, in other hospital admitted, multiple times due to hypercalcaemia attributed to high doses of per os calcium and vitamin D, and dosage was adjusted. Physical examination in the ED revealed that patient was lethargic but responsive in sample questions. Rest of clinical examination had no significant findings. The laboratory test showed that corrected calcium levels were elevated 13.3mg/dl. Calcium therapy was withheld and patient was treated with intravenous fluids and dieresis. Further clinical investigation and laboratory investigation, showed that 1.25(OH)2 vitD3 was elevated as well as serum ACE. Computing tomography (CT) was performed, revealing thoracic lymphadenopathy. Trans-bronchial biopsy of lymphatic tissue revealed granulomatous disease, compatible with sarcoidosis. Corticosteroid treatment was initiated, with methylprednisolone 32 mg following improvement in calcium levels. Cases of concomitant hypoparathyroidism and sarcoidosis are rare. Treatment of cases of concomitant sarcoidosis and collaboration between specialists.