Hypercalcaemia in an idiopathic hypoparathyroidism patient, due to sarcoidosis

Abstract

Idiopathic primary hypoparathyroidism is an infrequent disease among adults, especially if not associated with genetic disease such as Di George syndrome. Most commonly hypoparathyroidism is a result of surgical removal of the parathyroid glands during operation in the cervical area. Sarcoidosis is a multiorgan granulomatous disease, more frequently encountered than primary hypothyroidism. Hypocalcaemia is the most common finding in hypoparathyroidism. The opposite characterizes, hypercalcaemia is finding, in some cases of sarcoidosis due to 1.25(OH) 2 D 3 from granulomas. Concomitant idiopathic hypoparathyroidism and sarcoidosis has rarely been described. Here, we describe a rare case of an elderly woman with idiopathic primary hypoparathyroidism who developed hypercalcaemia attributed to underlying sarcoidosis. Case report A female 68 years old patient presented with five day duration of severe weakness, fatigue, nausea, vomiting and mild confusion. Previous medical history consisted of idiopathic hypoparathyroidism diagnosed ten years prior, diabetes mellitus, hypertension, chronic renal disease and an ischemic stroke 7 months prior (resulting in dysarthria). At the time of presentation the patient was treated with per os calcium with cholecalciferol (500 mg + 400 IU) tow times in day, insulin glargine, metformin, a beta-blocker, a calcium channel blocker and a thiazide diuretic (12,5 mg). In the past two years, patient was admitted multiple times due to hypercalcaemia attributed to high doses of calcium with cholecalciferol (1000 mg + 800 IU) tow times in day, and dosage was adjusted.