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Primary hyperparathyroidism and thiazide diuretics

P S Klimiuk, M Davies, P H Adams

    Postgraduate Medical Journal
    |February 1, 1981
    PubMed
    Summary
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    Thiazide diuretics can cause mild to moderate hypercalcemia, mimicking primary hyperparathyroidism. Stopping the diuretic often resolves hypercalcemia, suggesting it as a primary cause.

    Area of Science:

    • Nephrology
    • Endocrinology
    • Pharmacology

    Background:

    • Thiazide diuretics are commonly prescribed for hypertension and edema.
    • Hypercalcemia is a potential side effect of thiazide use.
    • Distinguishing thiazide-induced hypercalcemia from primary hyperparathyroidism is clinically important.

    Purpose of the Study:

    • To evaluate the effect of thiazide diuretic withdrawal on hypercalcemia in patients initially suspected of primary hyperparathyroidism.

    Main Methods:

    • Retrospective case review of six patients with hypercalcemia (serum calcium 2.65-2.98 mmol/l) receiving thiazide diuretics.
    • Monitoring serum calcium levels after discontinuation of thiazide therapy.

    Main Results:

    • All six patients presented with mild to moderate hypercalcemia.

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  • Withdrawal of thiazide diuretics led to a reduction in serum calcium levels in all patients.
  • One patient achieved normocalcemia after thiazide withdrawal.

    • Conclusions:

    • Thiazide diuretics can induce or exacerbate hypercalcemia, potentially mimicking primary hyperparathyroidism.
    • Discontinuation of thiazide diuretics should be considered in patients with unexplained hypercalcemia.
    • Observing the effect of withholding thiazides is a recommended first step before pursuing other treatments for hypercalcemia.