Coma due to hypercalcemia in a patient with Paget??s disease and multiple parathyroid adenomata

Ben-Asuly, Shlomo; Horne, Tifha; Goldschmidt, Z; Eyal, Z; Eliakim, M; Chowers, I.

doi:10.1097/00000441-197503000-00015

Cited by 14 publications

(5 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…These conditions causing increased bone turnover include Paget’s disease and immobilization. 1,2 HCTZ decreases urinary excretion of calcium and thus may also have contributed to the hypercalcemia. 3,4 Although ciprofloxacin and metronidazole were started 1 day prior to the development of hypercalcemia, to the best of our knowledge, there is no known association between hypercalcemia and ciprofloxacin or metronidazole.…”

Section: Discussionmentioning

confidence: 99%

Vitamin A and Hydrochlorothiazide Causing Severe Hypercalcemia in a Patient With Primary Hyperparathyroidism

Varghese

Khasawneh

Subramaniam

et al. 2019

Journal of Investigative Medicine High Impact Case Reports

View full text Add to dashboard Cite

Objective. To report a case of severe hypercalcemia, exacerbated by vitamin A supplementation and hydrochlorothiazide, in a patient with primary hyperparathyroidism. Methods. Clinical and laboratory findings are presented along with response to therapy. Results. A 68-year-old white female presented to the emergency department complaining of nausea, vomiting, and altered mental status. Laboratory findings revealed calcium 15.8 mg/dL (8.4-10.2), albumin 4.1 g/dL (3.8-4.8), and parathyroid hormone 62 pg/mL (14-64). Serum calcium improved after intravenous hydration with normal saline. Prior to this hospitalization, over-the-counter medications were significant for calcium (600 mg daily), vitamin A (11 000 IU daily), and vitamin D (800 IU daily).The patient’s prescription medications were significant for hydrochlorothiazide (12.5 mg daily). Twenty-four-hour urine calcium was subsequently found to be 146 mg (35-250). Myeloma, lymphoma, and sarcoidosis were ruled out as the etiology for hypercalcemia. The diagnosis of primary hyperparathyroidism was confirmed. She was treated surgically for primary hyperparathyroidism. The right and left superior parathyroid showed hypercellular parathyroid on pathology. The patient was normocalcemic after surgery. Conclusion. Previous reports suggest that very high doses of vitamin A is required to cause hypercalcemia. This case suggests that in a setting of primary hyperparathyroidism and hydrochlorothiazide therapy, vitamin A may contribute to the development of severe hypercalcemia in patients who are on calcium and vitamin D supplements. Given their biologic effects, public awareness needs to be created regarding the injudicious use of vitamins.

show abstract

Section: Discussionmentioning

confidence: 99%

Vitamin A and Hydrochlorothiazide Causing Severe Hypercalcemia in a Patient With Primary Hyperparathyroidism

Varghese

Khasawneh

Subramaniam

et al. 2019

Journal of Investigative Medicine High Impact Case Reports

View full text Add to dashboard Cite

show abstract

“…[2][3][4][5][6][7][8][9][10][11][12][13][14][15] The first study that analyzed the topic was published in 1978 by Posen et al 16 They retrospectively studied 173 patients with Paget disease and 105 patients with hyperparathyroidism and found 9 patients with both disorders. [2][3][4][5][6][7][8][9][10][11][12][13][14][15] The first study that analyzed the topic was published in 1978 by Posen et al 16 They retrospectively studied 173 patients with Paget disease and 105 patients with hyperparathyroidism and found 9 patients with both disorders.…”

Section: Discussionmentioning

confidence: 99%

Coexistence of Primary Hyperparathyroidism and Paget Disease

Polymeris¹,

Doumouchtsis²,

Karga³

2009

The Endocrinologist

View full text Add to dashboard Cite

A 76-year-old woman presented with a 2-month history of high serum calcium, low phosphate, and high levels of alkaline phosphatase. Serum parathyroid hormone, in repeated measurements, was inappropriately high for the high serum calcium levels and the patient had hypercalciuria. The diagnosis of primary hyperparathyroidism was made. The patient also had very high levels of serum alkaline phosphatase and high bone turnover. Her bone mineral density evaluation by dual energy x-ray absorptiometry showed osteoporosis in the lumbar spine and osteopenia in femoral neck. Skull radiographs and a further bone scintigraphic study with Tc-99m methylene diphosphonate revealed Paget disease. Successful parathyroidectomy was performed and a parathyroid adenoma was removed. On reevaluation, no evidence of residual hyperparathyroidism was found. Bone metabolism was improved but remained disordered. The patient was then treated with IV zolendronic acid.

show abstract

“…This probably follows the early findings of normal circulating concentrations of PTH and calcitonin in PDB (49,50) that led most investigators to conclude that hormonal factors had no role in the expression of the abnormal bone remodeling process. A number of 73 patients with the combination of PDB and primary HPT is estimated to have been reported in the literature (2–31) . This makes possible to speculate of an uncommon association between two relatively high incident clinical entities.…”

Section: Co‐existing Pdb and Primary Hptmentioning

confidence: 99%

“…Moreover, in patients with both disorders, the indication for parathyroidectomy (PTX) should include the potential post‐PTX improvement in pagetic biochemistry and symptoms (31) . The original report of a coma caused by hypercalcemia in a patient with PDB and multiple parathyroid adenomata (14) reinforces the need for early surgical treatment in primary HPT‐PDB association. On the other hand, in patients affected by primary HPT who exhibit high bone turnover after successful PTX, a diagnostic screening for PDB has to be proposed.…”

Section: Co‐existing Pdb and Primary Hptmentioning

confidence: 99%

“…S ince the first description of the co‐existence of Paget's disease of bone (PDB) and hyperparathyroidism (HPT) by Albright and Reifenstein, (1) the majority of reports appeared in the medical literature regarding the association of the two disorders have been largely limited to case reports (2–30) . The only available study that extensively analyzed the topic was published in 1999 by Gutteridge et al (31) Therefore, even if the overproduction of PTH is reported in 12–18% of PDB, (32,33) detailed studies in such patients are limited, and the differential clinical diagnosis between the more frequently PDB‐associated secondary HPT and the rarely PDB‐associated primary HPT can represent a difficult task for physicians lacking a training in bone and mineral metabolism.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

What Is the Relationship Between Paget's Disease of Bone and Hyperparathyroidism?

Brandi

Falchetti

2006

Journal of Bone and Mineral Research

View full text Add to dashboard Cite

Coma due to hypercalcemia in a patient with Paget??s disease and multiple parathyroid adenomata

Cited by 14 publications

References 0 publications

Vitamin A and Hydrochlorothiazide Causing Severe Hypercalcemia in a Patient With Primary Hyperparathyroidism

Vitamin A and Hydrochlorothiazide Causing Severe Hypercalcemia in a Patient With Primary Hyperparathyroidism

Coexistence of Primary Hyperparathyroidism and Paget Disease

What Is the Relationship Between Paget's Disease of Bone and Hyperparathyroidism?

Contact Info

Product

Resources

About