title: Severe hypercalcaemia secondary to isolated adrenocorticotrophic hormone deficiency and subacute thyroiditis.
abstract: Severe hypercalcaemia is usually due to either neoplastic disease or primary hyperparathyroidism. Rarer causes do exist, and exceptionally these may occur concomitantly. We describe the case of a 45-year-old man who presented in a debilitated state with severe hypercalcaemia (total serum calcium 3.56 mmol/L, albumin 35 g/L) and suppressed serum parathyroid hormone concentration. It was initially suspected that he had neoplastic disease, but routine thyroid function tests demonstrated evidence of thyrotoxicosis [thyroid-stimulating hormone <0.05 mU/L (0.15-3.5); free thyroxine 75 pmol/L (8-27); total tri-iodothyronine 7.0 nmol/L (1.0-2.6)], which was probably secondary to a silent or subacute thyroiditis. After extensive investigation, it was established that the patient also had isolated adrenocorticotrophic hormone deficiency, presumably secondary to lymphocytic hypophysitis. Glucocorticoid therapy resulted in a dramatic improvement in the patient's clinical state and 1 year later he remained euthyroid and normocalcaemic.
authors.affiliation: Department of Endocrinology, Royal Infirmary of Edinburgh, Edinburgh, UK. mark.strachan@luht.scot.nhs.uk
authors.forename: Mark W J
authors.initials: MW
authors.lastname: Strachan
authors.forename: James D
authors.initials: JD
authors.lastname: Walker
authors.forename: Alan W
authors.initials: AW
authors.lastname: Patrick
mesh_terms: D000324:Adrenocorticotropic Hormone / Q000097:blood / Q000172:deficiency*; D003937:Diagnosis, Differential; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D006934:Hypercalcemia / Q000097:blood / Q000188:drug therapy / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications; D010281:Parathyroid Hormone / Q000097:blood; D013966:Thyroiditis / Q000097:blood / Q000150:complications*; D013971:Thyrotoxicosis / Q000150:complications; D013974:Thyroxine / Q000097:blood; D014284:Triiodothyronine / Q000097:blood
chemical_list: D005938:Glucocorticoids; D010281:Parathyroid Hormone; D014284:Triiodothyronine; D000324:Adrenocorticotropic Hormone; D013974:Thyroxine