Hypercalcemia in a patient with tuberculous adrenal insufficiency.
OBJECTIVE
To raise awareness of hypercalcemia as a rare and at times inaugural manifestation of adrenal insufficiency.


METHODS
Evaluation of hypercalcemia in a 43-year-old man showed adrenal insufficiency. Biopsies of the testes and adrenal glands revealed epithelioid and giant cell lesions indicating tuberculosis. Although tuberculosis can contribute to hypercalcemia, this possibility was ruled out in our patient by the low serum 1,25-dihydroxy-vitamin D3 levels and return to normal of serum calcium and renal function under hormone replacement therapy. It should be noted, however, that a course of pamidronate was given.


CONCLUSIONS
The mechanism of hypercalcemia associated with adrenal insufficiency is controversial. Hyperparathyroidism was ruled out in our patient. Adrenal insufficiency should be considered in some patients with hypercalcemia.
Glémarec
Joëlle
J
Rheumatology department, Nantes Teaching Hospital, France. joelle.glemarec@chu-nantes.fr
Varin
Stéphane
S
Rodet
Denis
D
Guillot
Pascale
P
Prost
Alain
A
Maugars
Yves
Y
Berthelot
Jean-Marie
JM
D000309:Adrenal Insufficiency / Q000097:blood / Q000150:complications / Q000473:pathology*; D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use; D002117:Calcitriol / Q000097:blood; D004359:Drug Therapy, Combination; D005438:Fludrocortisone / Q000627:therapeutic use; D020249:Hormone Replacement Therapy; D006801:Humans; D006854:Hydrocortisone / Q000627:therapeutic use; D006934:Hypercalcemia / Q000097:blood / Q000209:etiology / Q000473:pathology*; D008297:Male; D016896:Treatment Outcome; D014383:Tuberculosis, Endocrine / Q000150:complications / Q000209:etiology / Q000473:pathology*
D000995:Antitubercular Agents; D002117:Calcitriol; D005438:Fludrocortisone; D006854:Hydrocortisone