Congenital mastoid cholesteatoma presenting as a mass obstructing external auditory canal.
We describe the clinical presentation, investigation and management of an eventually fatal case of hypercalcemic crisis due to primary hyperparathyridism (PHPT). A 60 year-old lady with history of urolithiasis presented with worsening generalized bone pain, spinal scoliosis and a limp. Laboratory data showed hypercalcemia and raised alkaline phosphatase. Left hip x-ray revealed a subcapital femoral neck fracture. Intact parathyroid hormone was elevated, 187.6 pmol/L (1.6 - 6.9) and ultrasound showed an enlarged right parathyroid gland. Despite initial reduction of serum calcium with saline infusion and multiple doses of intravenous pamidronate, her calcium increased to 4.14 mmol/L a week following application of Buck's traction for persistent left hip pain. She succumbed eventually with serum calcium peaking at 6.28 mmol/L despite multiple therapeutic interventions.
Sarawak General Hospital, Medical Department, Jalan Hospital, 93586 Kuching, Sarawak, Malaysia. kychien2006@yahoo.com.
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Khairunnisak
Sarawak General Hospital, Medical Department, Jalan Hospital, 93586 Kuching, Sarawak, Malaysia.
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Mohd Khairi