Development of hypercalcemic crisis in a Graves' hyperthyroid patient associated with central diabetes insipidus.
A 26-year-old man with Graves' hyperthyroidism associated with central diabetes insipidus (DI), initially showed hypercalcemic crisis. Initially, very low serum levels of intact parathyroid hormone (PTH) and 1,25-dihydroxy vitamin D3 and a moderate rise of serum C-terminal PTH related protein (C-PTHrP) were observed which strongly suggested a humoral hypercalcemia of malignancy due to PTHrP. However, the serum C-PTHrP level later became normal. Mild hyperprolactinemia, no responses of growth hormone (GH) to insulin-induced hypoglycemia despite a normal growth hormone releasing hormone (GRH) test and mild thickening of the pituitary stalk on magnetic resonance imaging were observed. Thus, an autoimmune nature of his central DI is considered; it is noteworthy that the serum C-PTHrP level may be elevated by renal failure in patients with hypercalcemia due to causes other than PTHrP.
Endo
A
A
First Department of Internal Medicine, Faculty of Medicine, Tottori University, Yonago.
Shigemasa
C
C
Kouchi
T
T
Taniguchi
S
S
Ueta
Y
Y
Yoshida
A
A
Mashiba
H
H
D000208:Acute Disease; D000328:Adult; D003919:Diabetes Insipidus / Q000097:blood / Q000150:complications*; D006111:Graves Disease / Q000097:blood / Q000150:complications*; D006801:Humans; D006934:Hypercalcemia / Q000097:blood / Q000209:etiology*; D008297:Male; D010281:Parathyroid Hormone / Q000097:blood; D044162:Parathyroid Hormone-Related Protein; D011506:Proteins / Q000378:metabolism
C470121:PTHLH protein, human; D010281:Parathyroid Hormone; D044162:Parathyroid Hormone-Related Protein; D011506:Proteins