Concurrent Primary Hyperparathyroidism and Sarcoidosis in a Patient With Severe Hypercalcemia

Ayyad, Mohammed; Khaleel, Mansour; Albandak, Maram; Abedalhameed, Hadeel K. M.; Najjar, Mohab W. J.

doi:10.7759/cureus.44669

Cited by 2 publications

(1 citation statement)

References 17 publications

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“…The etiology of moderate-severe hypercalcemia is often multifactorial, however, over 90% of cases are due to primary hyperparathyroidism or malignancy [10]. Lesser known causes include familial hypocalciuric hypercalcemia, granulomatous disorders, vitamin D intoxication, hyperthyroidism, vitamin A intoxication, multiple myeloma, and milk-alkali syndrome [11].…”

Section: Discussionmentioning

confidence: 99%

Calcium Chaos in Sarcoidosis: A Tale of Severe Hypercalcemia's Diagnostic Challenge

Satasia,

Garg,

Weerasinghe

et al. 2024

Cureus

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Sarcoidosis is a systemic inflammatory condition characterized by noncaseating granulomas. Lung involvement is typical, while extrapulmonary manifestations, notably lymphadenopathy, are observed in a significant proportion of cases. The etiology involves complex interactions among immune cells and mediators, resulting in granuloma formation capable of independently producing 1,25-dihydroxyvitamin D, leading to unregulated hypercalcemia and hypercalciuria. Diagnosis can be challenging, especially when hypercalcemia is the initial symptom. The presence of noncaseating granulomas on biopsy is characteristic of sarcoidosis. We present a case of severe hypercalcemia in a 53-year-old woman, initially suggestive of primary hyperparathyroidism due to non-suppressed intact parathyroid hormone (PTH) levels and unilateral intrathyroidal tracer uptake on a technetium 99m sestamibi parathyroid scan. The patient presented with hypertension, acute kidney injury, and severe hypercalcemia. Initial assessment, including a parathyroid scan, hinted at primary hyperparathyroidism. However, further evaluation, including chest computed tomography (CT) and endobronchial biopsy, revealed sarcoidosis with noncaseating granulomas. Prednisone therapy led to normalization of serum calcium and creatinine levels. The case underscores the complexities in diagnosing sarcoidosis, especially when presenting with severe hypercalcemia. Despite non-suppressed PTH and suggestive imaging, the final diagnosis relied on endobronchial biopsy findings. The study highlights the limitations of conventional diagnostic markers, emphasizing the need for a comprehensive and individualized approach.

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Section: Discussionmentioning

confidence: 99%

Calcium Chaos in Sarcoidosis: A Tale of Severe Hypercalcemia's Diagnostic Challenge

Satasia,

Garg,

Weerasinghe

et al. 2024

Cureus

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Hypercalcemia Etiologies in Pediatric Patients: An Informative Narrative Review

Dalili,

Basiri,

Koohmanaee

et al. 2024

J Compr Ped

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Background: Hypercalcemia, although less prevalent, is a critical diagnosis in pediatric patients, consisting of numerous etiologies that differ significantly from those in adults. In children, congenital causes are more prevalent. The differential diagnosis of hypercalcemia encompasses a broad spectrum of etiologies; however, up to 90% of all cases are diagnosed with either primary hyperparathyroidism or malignancy. Primary hyperparathyroidism predominates in ambulatory patients, while malignancy is more common among critically ill hospitalized patients. Objectives: This review addresses several important issues related to calcium metabolism and hypercalcemia: a) Overview of Calcium Metabolism b) Factors affecting serum total and ionized calcium concentration c) Clinical manifestations and importance of Hypercalcemia in pediatric patients d) Overview of the causes of Hypercalcemia in pediatric patients e) Overview of Hypercalcemia management Methods: A literature search was conducted for articles published from 2000 to 2024 using PubMed, Scopus, Web of Science, Cochrane, and Embase databases. The keywords used were: CALCIUM, Calcium metabolism disorders, hypercalcemia, Parathyroid hormone, Vitamin D, and acid-base imbalance. Results: This study provides a review of calcium metabolism and factors affecting total and ionized calcium concentrations, along with a definition of hypercalcemia, classification of its severity, its clinical manifestations, and a comprehensive overview of hypercalcemia etiologies categorized into parathyroid hormone (PTH)-related and unrelated causes. An overview of its management is also included. Conclusions: Hypercalcemia is an important disorder in both pediatric and adult patients. Before initiating a workup for hypercalcemia, it is crucial to understand the physiology of calcium and the factors affecting its serum concentrations. The etiologies of hypercalcemia in pediatric patients have a wide spectrum of differential diagnoses; primary hyperparathyroidism and malignancies account for 80-90% of all hypercalcemia cases found in clinical practice. Genetic and syndromic causes are usually more prevalent in pediatrics due to the nature of these conditions. Managing hypercalcemia requires two simultaneous approaches: first, measures aimed at lowering serum calcium concentrations and second, a workup for the underlying cause.

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Concurrent Primary Hyperparathyroidism and Sarcoidosis in a Patient With Severe Hypercalcemia

Cited by 2 publications

References 17 publications

Calcium Chaos in Sarcoidosis: A Tale of Severe Hypercalcemia's Diagnostic Challenge

Calcium Chaos in Sarcoidosis: A Tale of Severe Hypercalcemia's Diagnostic Challenge

Hypercalcemia Etiologies in Pediatric Patients: An Informative Narrative Review

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