Non-parathyroid hypercalcemia in a patient with new-onset hyperthyroidism and silicone-induced granulomas: case report
BackgroundHypercalcemia is a frequent occurrence in hospitalized patients. It can vary in presentation and severity, and appropriate treatment requires targeting of the underlying condition. Rarer causes of hypercalcemia, such as hyperthyroidism and granulomatous diseases, need to be addressed after...
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Frontiers Media S.A.
2025-01-01
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| Series: | Frontiers in Endocrinology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fendo.2024.1447652/full |
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| author | Laura Montefusco Giada Rossi Iulia Petria Ida Pastore Ida Pastore Paolo Fiorina Paolo Fiorina Paolo Fiorina Paolo Fiorina |
| author_facet | Laura Montefusco Giada Rossi Iulia Petria Ida Pastore Ida Pastore Paolo Fiorina Paolo Fiorina Paolo Fiorina Paolo Fiorina |
| author_sort | Laura Montefusco |
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| description | BackgroundHypercalcemia is a frequent occurrence in hospitalized patients. It can vary in presentation and severity, and appropriate treatment requires targeting of the underlying condition. Rarer causes of hypercalcemia, such as hyperthyroidism and granulomatous diseases, need to be addressed after excluding the more prevalent etiologies, namely primary hyperparathyroidism and malignancies. We report a case of moderate hypercalcemia in a patient with HIV-positivity with new-onset autoimmune hyperthyroidism as well as concomitant chronic granulomas due to silicone injections.Case summaryA 61-year-old patient presented with generalized malaise, asthenia, dyspnea and dysphagia associated with rapid weight loss and recurrent panic attacks. Biochemical work-up revealed moderate hypercalcemia and overt hyperthyroidism with positive anti-TSH-receptor antibodies. Hydration, loop diuretics and methimazole were initiated immediately. Suppressed parathyroid hormone (PTH) levels excluded PTH-mediated hypercalcemia (e.g., primary hyperparathyroidism) and among causes of non-PTH-mediated hypercalcemia, malignancies were excluded. Granulomas secondary to past silicone injections were also found in our patient, however normal 1,25-dihydroxy vitamin D3 levels. Treatment of hyperthyroidism with normalization of thyroid function tests was simultaneously followed by improvement of calcium and PTH levels supporting the diagnosis of hypercalcemia secondary to Graves’ disease.Learning pointsHyperthyroidism is a rare cause of hypercalcemia, but it has to be considered in suggestive clinical settings. In our case, prompt management of Graves’ disease contributed to the normalization of calcium levels. This, in turn, supported the differential diagnosis of non-PTH-mediated hypercalcemia. |
| format | Article |
| id | doaj-art-26c1e7e046744582acb034e04bae3629 |
| institution | Kabale University |
| issn | 1664-2392 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Endocrinology |
| spelling | doaj-art-26c1e7e046744582acb034e04bae36292025-01-21T05:43:23ZengFrontiers Media S.A.Frontiers in Endocrinology1664-23922025-01-011510.3389/fendo.2024.14476521447652Non-parathyroid hypercalcemia in a patient with new-onset hyperthyroidism and silicone-induced granulomas: case reportLaura Montefusco0Giada Rossi1Iulia Petria2Ida Pastore3Ida Pastore4Paolo Fiorina5Paolo Fiorina6Paolo Fiorina7Paolo Fiorina8Division of Endocrinology, Azienda Socio Sanitaria Territoriale (ASST) Fatebenefratelli-Sacco, Milan, ItalyDipartimento di Scienze Biomediche e Cliniche, University of Milan, Milan, ItalyDipartimento di Scienze Biomediche e Cliniche, University of Milan, Milan, ItalyDivision of Endocrinology, Azienda Socio Sanitaria Territoriale (ASST) Fatebenefratelli-Sacco, Milan, ItalyDipartimento di Scienze Biomediche e Cliniche, University of Milan, Milan, ItalyDivision of Endocrinology, Azienda Socio Sanitaria Territoriale (ASST) Fatebenefratelli-Sacco, Milan, ItalyDipartimento di Scienze Biomediche e Cliniche, University of Milan, Milan, ItalyNephrology Division, Boston Children’s Hospital, Harvard Medical School, Boston, MA, United StatesInternational Center for T1D, Pediatric Clinical Research Center Romeo ed Enrica Invernizzi, Dipartimento di Scienze Biomediche e Cliniche (DIBIC), University of Milan, Milan, ItalyBackgroundHypercalcemia is a frequent occurrence in hospitalized patients. It can vary in presentation and severity, and appropriate treatment requires targeting of the underlying condition. Rarer causes of hypercalcemia, such as hyperthyroidism and granulomatous diseases, need to be addressed after excluding the more prevalent etiologies, namely primary hyperparathyroidism and malignancies. We report a case of moderate hypercalcemia in a patient with HIV-positivity with new-onset autoimmune hyperthyroidism as well as concomitant chronic granulomas due to silicone injections.Case summaryA 61-year-old patient presented with generalized malaise, asthenia, dyspnea and dysphagia associated with rapid weight loss and recurrent panic attacks. Biochemical work-up revealed moderate hypercalcemia and overt hyperthyroidism with positive anti-TSH-receptor antibodies. Hydration, loop diuretics and methimazole were initiated immediately. Suppressed parathyroid hormone (PTH) levels excluded PTH-mediated hypercalcemia (e.g., primary hyperparathyroidism) and among causes of non-PTH-mediated hypercalcemia, malignancies were excluded. Granulomas secondary to past silicone injections were also found in our patient, however normal 1,25-dihydroxy vitamin D3 levels. Treatment of hyperthyroidism with normalization of thyroid function tests was simultaneously followed by improvement of calcium and PTH levels supporting the diagnosis of hypercalcemia secondary to Graves’ disease.Learning pointsHyperthyroidism is a rare cause of hypercalcemia, but it has to be considered in suggestive clinical settings. In our case, prompt management of Graves’ disease contributed to the normalization of calcium levels. This, in turn, supported the differential diagnosis of non-PTH-mediated hypercalcemia.https://www.frontiersin.org/articles/10.3389/fendo.2024.1447652/fullhypercalcemiahyperthyroidismgranulomatosistumor-induced hypercalcemiacase report |
| spellingShingle | Laura Montefusco Giada Rossi Iulia Petria Ida Pastore Ida Pastore Paolo Fiorina Paolo Fiorina Paolo Fiorina Paolo Fiorina Non-parathyroid hypercalcemia in a patient with new-onset hyperthyroidism and silicone-induced granulomas: case report Frontiers in Endocrinology hypercalcemia hyperthyroidism granulomatosis tumor-induced hypercalcemia case report |
| title | Non-parathyroid hypercalcemia in a patient with new-onset hyperthyroidism and silicone-induced granulomas: case report |
| title_full | Non-parathyroid hypercalcemia in a patient with new-onset hyperthyroidism and silicone-induced granulomas: case report |
| title_fullStr | Non-parathyroid hypercalcemia in a patient with new-onset hyperthyroidism and silicone-induced granulomas: case report |
| title_full_unstemmed | Non-parathyroid hypercalcemia in a patient with new-onset hyperthyroidism and silicone-induced granulomas: case report |
| title_short | Non-parathyroid hypercalcemia in a patient with new-onset hyperthyroidism and silicone-induced granulomas: case report |
| title_sort | non parathyroid hypercalcemia in a patient with new onset hyperthyroidism and silicone induced granulomas case report |
| topic | hypercalcemia hyperthyroidism granulomatosis tumor-induced hypercalcemia case report |
| url | https://www.frontiersin.org/articles/10.3389/fendo.2024.1447652/full |
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