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      Life-Threatening Hypercalcemia due to Graves' Disease and Concomitant Adrenal Failure: A Case Report and Review of the Literature

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          Abstract

          A 47-year-old woman presented with the complaints of nausea, vomiting, and weight loss. She had a history of bilateral surrenalectomy due to Cushing's syndrome. On examination she had tachycardia and orthostatic hypotension. Laboratory examinations revealed hypercalcemia and suppressed parathyroid hormone levels. She also had thyrotoxicosis due to Graves' disease. The investigations to rule out a malignancy were negative. With steroid, zoledronic acid, and antithyroid drug treatment her symptoms were resolved and calcium level was normalized. This case highlights the importance of recognizing thyrotoxicosis and concomitant adrenal failure as a possible cause of severe hypercalcemia.

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          Bone disease in thyrotoxicosis

          P. Amaresh Reddy, C. Harinarayan, Alok Sachan … (2012)
          Thyrotoxicosis, a clinical syndrome characterized by manifestations of excess thyroid hormone, is one of the commonly-recognised conditions of the thyroid gland. Thyrotoxicosis causes acceleration of bone remodelling and though it is one of the known risk factors for osteoporosis, the metabolic effects of thyroxine on bone are not well discussed. Studies show that thyroid hormones have effects on bone, both in vitro and in vivo. Treatment of thyrotoxicosis leads to reversal of bone loss and metabolic alterations, and decreases the fracture risk. There are limited studies in India as to whether these changes are fully reversible. In this review we discuss about the effects of thyrotoxicosis (endogenous and exogenous) on bone and mineral metabolism, effects of subclinical thyrotoxicosis on bone and mineral metabolism and effects of various forms of treatment in improving the bone mineral density in thyrotoxicosis.
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            Zoledronic acid inhibits human osteoblast activities.

            Fernanda G. Basso, Carlos A. de Souza Costa, Josimeri HEBLING … (2013)
            Bisphosphonates are potent inhibitors of bone resorption. These kinds of drugs, which are used for the treatment of osteolytic diseases, have been associated with the occurrence of oral osteonecrosis, especially in patients over 60 years old. Current studies have demonstrated that the cytotoxic effects of bisphosphonates on osteoblasts play an important role in oral osteonecrosis development.
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              Endocrine and metabolic emergencies: hypercalcaemia.

              Richard A. Carroll, Glenn Matfin (2010)
              Hypercalcaemia is commonly seen in the context of parathyroid dysfunction and malignancy and, when severe, can precipitate Life-threatening sequelae. The differential of hypercalcaemia is broad and can be categorized based on parathyroid hormone (PTH) Levels. The acute management of severe hypercalcaemia is discussed along with a brief review of therapeutic advances in the field.
              Article 0 comments Cited 13 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Case Rep Endocrinol
                Journal ID (iso-abbrev): Case Rep Endocrinol
                Journal ID (publisher-id): CRIE
                Title: Case Reports in Endocrinology
                Publisher: Hindawi Publishing Corporation
                ISSN (Print): 2090-6501
                ISSN (Electronic): 2090-651X
                Publication date (Print): 2015
                Publication date (Electronic): 24 March 2015
                Volume: 2015
                Electronic Location Identifier: 684648
                Affiliations
                Endocrinology and Metabolism, Cerrahpasa Medical School, University of Istanbul, 34098 Istanbul, Turkey
                Author notes

                Academic Editor: Yuji Moriwaki

                Article
                DOI: 10.1155/2015/684648
                PMC ID: 4388017
                SO-VID: 3bb79e65-3cbf-471a-9c42-f3d31a0eb1bf
                Copyright © Copyright © 2015 Hande Mefkure Ozkaya et al.
                License:

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 12 February 2015
                Date accepted : 13 March 2015
                Categories
                Subject: Case Report

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