Hypercalcemia accompanied by hypothalamic hypopituitarism, central diabetes inspidus and hyperthyroidism.
We present here a case of prominent hypercalcemia accompanied by hypothalamic tumor and Graves' disease. A 24-year-old man with hypothalamic tumor showed hypopituitarism, central diabetes inspidus (DI) and hyperthyroidism. Nausea, loss of thirst and appetite, and general fatigue were found with the unveiling of hypercalcemia and hypernatremia. Parathyroid hormone (PTH) and 1alpha-dihydroxyvitamin D levels were suppressed with a normal range of PTH-related protein values. One-desamino-(8-D-arginine)-vasopressin (DDAVP) and half-saline administration normalized hypernatremia, while hypercalcemia was still sustained. Administration of cortisone acetate and thiamazole reduced the elevated serum Ca level. In the present case, concurrent hyperthyroidism was assumed to accelerate skeletal mobilization of calcium into the circulation. Hypocortisolism and central DI was also considered to contribute, to some extent, to the hypercalcemia through renal handling of Ca.
Wada
S
S
Fourth Department of Internal Medicine, Saitama Medical School, Moroyama. wadas@saitama-med.ac.jp
Kurihara
S
S
Imamaki
K
K
Yokota
K
K
Kitahama
S
S
Yamanaka
K
K
Itabashi
A
A
Iitaka
M
M
Katayama
S
S
D000328:Adult; D013956:Antithyroid Agents / Q000627:therapeutic use; D002117:Calcitriol / Q000097:blood; D002118:Calcium / Q000097:blood; D003348:Cortisone / Q000031:analogs & derivatives / Q000627:therapeutic use; D003399:Craniotomy; D003894:Deamino Arginine Vasopressin / Q000627:therapeutic use; D003919:Diabetes Insipidus / Q000097:blood / Q000150:complications* / Q000188:drug therapy; D004359:Drug Therapy, Combination; D018237:Germinoma / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D006111:Graves Disease / Q000097:blood / Q000150:complications / Q000188:drug therapy; D006801:Humans; D006934:Hypercalcemia / Q000097:blood / Q000150:complications* / Q000188:drug therapy; D006955:Hypernatremia / Q000097:blood / Q000150:complications / Q000188:drug therapy; D006980:Hyperthyroidism / Q000097:blood / Q000150:complications* / Q000188:drug therapy; D007018:Hypopituitarism / Q000097:blood / Q000150:complications* / Q000188:drug therapy; D007029:Hypothalamic Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D008713:Methimazole / Q000627:therapeutic use; D010281:Parathyroid Hormone / Q000097:blood; D044162:Parathyroid Hormone-Related Protein; D010446:Peptide Fragments / Q000097:blood; D011506:Proteins; D012076:Renal Agents / Q000627:therapeutic use; D012964:Sodium / Q000097:blood; D013724:Teratoma / Q000150:complications* / Q000175:diagnosis / Q000601:surgery
D013956:Antithyroid Agents; C470121:PTHLH protein, human; D010281:Parathyroid Hormone; D044162:Parathyroid Hormone-Related Protein; D010446:Peptide Fragments; D011506:Proteins; D012076:Renal Agents; C071784:parathyroid hormone-related protein (107-111); D008713:Methimazole; D012964:Sodium; D003894:Deamino Arginine Vasopressin; D002117:Calcitriol; D002118:Calcium; D003348:Cortisone