Etiology of hypercalcemia in a patient with Addison's disease
- 416 Downloads
A case is reported of a hypercalcemic patient with primary Addison's disease. A combination of increased calcium input into the extracellular space and reduced calcium removal by the kidney accounted for the hypercalcemia. The mechanisms responsible for the reduction in calcium removal were decreased glomerular filtration and increased tubular calcium reabsorption. Both renal factors were secondary to volume depletion and improved rapidly during rehydration with saline infusion. The enhanced calcium mobilization was probably of skeletal origin. It persisted irrespective of volume status until hydrocortisone treatment was instituted. Serum 1,25-dihydroxyvitamin D3 levels were below 10 pg/ml, even after normalization of the glomerular filtration rate, but returned slowly to the normal range during corticosteroid substitution. Serum 25-hydroxyvitamin D3 and parathyroid hormone levels were within the normal range. Our case report therefore demonstrates that physiological amounts of glucocorticoids reduce bone resorption, normalize serum calcium, and restore the production of 1,25-dihydroxyvitamin D3.
Key wordsHypercalcemia Addison's disease Glucocorticoids 1,25-dihydroxyvitamin D3
Unable to display preview. Download preview PDF.
- 7.Landerson H, Bowers GN (1973) Free calcium in serum. Determination with the ion-specific electrode and factors affecting the results. Clin Chem 19:565–574Google Scholar
- 11.Nordin BEC, Horsman A, Aron J (1976) Diagnostic procedures. In: Nordin BEC (ed) Calcium, phosphate and magnesium metabolism. Churchill Livingstone, Edingburgh, pp 469–524Google Scholar
- 12.Goldberg M, Agus Z, Goldfarb S (1976) Renal handling of phosphate, calcium and magnesium. In: Brenner BM, Rector FC (eds) The kidney. WB Saunders Co, Philadelphia, pp 340–390Google Scholar
- 13.Walker DA, Davies M (1981) Addison's disease presenting as a hypercalcaemic crisis in a patient with idiopathic hypoparathyroidism. Clin Endocrinol 14:419–423Google Scholar
- 15.Spanos E, MacIntyre I (1977) Effect of glucocorticoids on vitamin D—metabolism. In: Norman AW (ed) Biochemical, chemical and clinical aspects related to calcium metabolism. Walter de Gruyter, Berlin, pp 191–195Google Scholar