CASE REPORT


A Simplified Approach to the Management of Hypercalcemia



Ravneet Bajwa1, Ami Amin1, Bhavika Gandhi1, Sarmed Mansur1, Alireza Amirpour1, Tejas Karawadia1, Priya Patel1, Eric J. Costanzo1, Mohammad A. Hossain1, *, Jennifer Cheng2, Mayurkumar Patel3, Tushar Vachharajani4, Arif Asif1
1 Department of Internal Medicine, Jersey Shore University Medical Center, Neptune, New Jersey, USA
2 Department of Endocrinology, Jersey Shore University Medical Center, Neptune, New Jersey, USA
3 Division of Nephrology and Hypertension, Jersey Shore University Medical Center, Neptune, New Jersey, USA
4 Division of Nephrology, Salisbury VA Health Care System, Salisbury, NC and Department of Nephrology, University of North Carolina, Chapel Hill, NC, USA


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© 2018 Bajwa et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Internal Medicine Residency Program, Department of Medicine, Jersey Shore University Medical Center, 1945 State Route 33, Neptune, NJ 07753 USA; Tel: 516-225-8099; E-mail: Mohammad.Hossain@HackensackMeridian.org


Abstract

Introduction:

While patients with hypercalcemia can be treated with various treatment options including volume expansion, loop diuretics, calcitonin, bisphosphonate, sensipar; hypercalcemia can be resistant to these measures.

Case Description:

In this report, we present two elderly patients with hypercalcemia resistant to traditional therapy. Both had parathyroid tumor. Early diagnosis could not be established. Both patients required hemodialysis. Hypercalcemia was controlled in the 74-year old who successfully underwent surgery with normalization of calcium level. The 79-year old was not considered a surgical candidate and was transitioned to hospice.

Discussion & Conclusion:

Primary hyperparathyroidism is an important cause of hypercalcemia. In order to reduce morbidity and mortality, its diagnosis must be established earlier on. These case reports prepared with residents/junior faculty will benefit other trainees with the diagnosis and management of refractory hypercalcemia and highlight a teaching point that prompt diagnosis of primary hyperparathyroidism can have a major positive impact on the overall management of hypercalcemia.

Keywords: Resistant hypercalcemia, Parathyroid adenoma, Parathyroid carcinoma, Hemodialysis, Parathyroidectomy, Hyperparathyroidism.