Hypercalcemic crisis due to primary hyperparathyroidism occurring concomitantly with Graves' disease

Area of Science:

• Endocrinology
• Internal Medicine
• Case Study

Background:

• Hypercalcemic crisis is a rare but serious condition characterized by extremely high serum calcium levels.
• Primary hyperparathyroidism and Graves' disease are endocrine disorders that can independently cause hypercalcemia.

Observation:

• A 52-year-old Japanese woman presented with symptoms of thirst and fatigue, indicative of hypercalcemia.
• Her serum calcium levels were critically elevated at 19.0 mg/dL, leading to a diagnosis of hypercalcemic crisis.
• Elevated parathyroid hormone and thyroid hormone levels were detected concurrently.

Findings:

• The patient was diagnosed with concurrent primary hyperparathyroidism and Graves' disease, both contributing to the hypercalcemic crisis.
• A thyroparathyroidectomy was performed, which successfully normalized both serum calcium and thyroid hormone levels.

Implications:

• This case highlights the importance of considering the coexistence of primary hyperparathyroidism and Graves' disease in patients presenting with hypercalcemia.
• Simultaneous endocrine disorders can potentiate hypercalcemia, necessitating comprehensive diagnostic evaluation and tailored treatment strategies.
• Early recognition and management of combined endocrine conditions are crucial for resolving hypercalcemic crisis and preventing recurrence.