An unrecognized cause of recurrent hypercalcemia: immobilization

Chih-Jen Cheng; Chung-Hsing Chou; Shih-Hua Lin

doi:10.1097/01.smj.0000210142.76331.b4

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An unrecognized cause of recurrent hypercalcemia: immobilization

Journal article

Peer reviewed

An unrecognized cause of recurrent hypercalcemia: immobilization

Chih-Jen Cheng, Chung-Hsing Chou and Shih-Hua Lin

Southern medical journal (Birmingham, Ala.), Vol.99(4), pp.371-374

04/01/2006

DOI: 10.1097/01.smj.0000210142.76331.b4

PMID: 16634246

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Abstract

We report a 66-year-old Chinese man with chronic renal insufficiency (creatinine 1.7 mg/dL) and gout suffering from slurred speech and right hemiplegia for 3 days. Acute cerebral infarction was confirmed by computed tomography. Conscious disturbance occurred on the tenth hospital day without significant changes on imaging study when compared with a previous scan. Hypercalcemia (total calcium 14.1 mg/dL) and acute exacerbation of chronic renal failure (serum creatinine 2.5 mg/dL) were noticed. Hypercalciuria (FECa 3.2%), and low serum levels of intact parathyroid hormone and 1,25(OH)2D3 suggested nonparathyroidal hypercalcemia. An extensive workup failed to identify any etiology of hypercalcemia. Hypercalcemia and renal failure were temporarily ameliorated after aggressive volume expansion and loop diuretic treatment but recurred 2 weeks later. Immobilization hypercalcemia was considered after the exclusion of other discernible causes and was successfully treated with rehabilitative exercises and bisphosphonates without further recurrence during a 2-year follow-up. Clinical alertness to immobilization as a possible cause of hypercalcemia may avoid unnecessary and invasive examinations, life-threatening complications and annoying recurrences.

Aged

Bone Density Conservation Agents - therapeutic use

Calcium - urine

Diphosphonates - therapeutic use

Exercise Therapy

Gout - complications

Humans

Hypercalcemia - complications

Hypercalcemia - etiology

Hypercalcemia - therapy

Immobilization - adverse effects

Infarction, Middle Cerebral Artery - complications

Infarction, Middle Cerebral Artery - diagnostic imaging

Kidney Failure, Chronic - complications

Male

Parathyroid Hormone - blood

Radiography

Recurrence

Steroid Hydroxylases - blood

Details

Title: Subtitle: An unrecognized cause of recurrent hypercalcemia: immobilization
Creators: Chih-Jen Cheng - National Defense Medical Center
Chung-Hsing Chou
Shih-Hua Lin
Resource Type: Journal article
Publication Details: Southern medical journal (Birmingham, Ala.), Vol.99(4), pp.371-374
DOI: 10.1097/01.smj.0000210142.76331.b4
PMID: 16634246
ISSN: 0038-4348
eISSN: 1541-8243
Language: English
Date published: 04/01/2006
Academic Unit: Nephrology; Internal Medicine
Record Identifier: 9984383900402771

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