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Hypercalcaemia in acute adrenal insufficiency. A case report.
T Pieters1, J P Devogelaer, H Meunier
1Départment de Médecine Interne, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Bruxelles.
Acta Clinica Belgica
|January 1, 1990
Summary
A 62-year-old woman experienced septic shock and pulmonary embolism, leading to acute adrenal insufficiency and hypercalcemia. Cortisone replacement therapy successfully treated her condition, normalizing calcium levels.
Area of Science:
- Endocrinology
- Critical Care Medicine
- Nephrology
Background:
- A 62-year-old female patient developed severe complications including septic shock and pulmonary embolism following extensive burn skin grafting.
- Initial treatment involved anticoagulation, but the patient experienced a second shock episode, resulting in renal insufficiency.
Observation:
- The patient subsequently developed hypercalcemia (high blood calcium).
- Imaging revealed enlarged adrenal glands, prompting suspicion of acute adrenal hemorrhage.
- Low plasma and urine cortisol levels, unresponsive to ACTH stimulation, confirmed acute adrenal insufficiency.
Findings:
- Cortisone replacement therapy was initiated.
- The patient's condition significantly improved, and her plasma calcium levels normalized following hormone replacement.
Implications:
- This case highlights a potential link between acute adrenal insufficiency and hypercalcemia.
- Discusses proposed mechanisms for hypercalcemia in adrenal insufficiency, including hemoconcentration, altered protein binding, increased calcium complexes, and skeletal calcium mobilization.
- Emphasizes the importance of recognizing and managing adrenal insufficiency in critically ill patients with unexplained hypercalcemia.