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A Diagnostic Journey.

Dhairya Thakker1, Adway Kulkarni2, Ashit V Hegde3

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Diabetic ketoacidosis was caused by acute pancreatitis, stemming from hypercalcemia due to primary hyperparathyroidism. The patient also had a malignant thyroid nodule and hypertrophic obstructive cardiomyopathy.

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Area of Science:

  • Endocrinology
  • Cardiology
  • Oncology

Background:

  • Diabetic ketoacidosis (DKA) is a serious complication of diabetes.
  • Acute pancreatitis can present with diverse etiologies.
  • Hypercalcemia is associated with various endocrine and neoplastic conditions.

Observation:

  • A patient presented with DKA, which was found to be secondary to acute pancreatitis.
  • Further investigation revealed hypercalcemia as the cause of pancreatitis, linked to primary hyperparathyroidism.
  • Incidental findings included a malignant thyroid nodule and hypertrophic obstructive cardiomyopathy.

Findings:

  • Established a causal link between primary hyperparathyroidism, hypercalcemia, acute pancreatitis, and DKA.
  • Diagnosed a concurrent malignant thyroid nodule.
  • Identified hypertrophic obstructive cardiomyopathy.

Implications:

  • Highlights the importance of investigating metabolic derangements in DKA.
  • Underscores the multi-systemic impact of primary hyperparathyroidism.
  • Emphasizes the value of thorough evaluation in complex clinical presentations.