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Disorders of Mineral Homeostasis

  • Anil Bhansali
  • Yashpal Gogate

Abstract

A 55-year-old male presented with epigastric pain for the past 6 weeks. It was intermittent, moderate in severity, and associated with nausea and vomiting. He also had anorexia, constipation, and weight loss of 15 kg in the last 6 months. He underwent pyelolithotomy 2 months back for renal stone disease. There was no history of gallstone disease, bone pains, or fragility fracture. He was nonalcoholic and nonsmoker. On examination, he was dehydrated with a blood pressure 90/72 mmHg, pulse rate 126/min, and central venous pressure 2 cm H2O. Abdominal examination revealed a 10 × 8 cm mass in the epigastrium extending to right hypochondrium. Ultrasonography of the abdomen showed a bulky pancreas with multiple collections in the peripancreatic region. On investigations, hemoglobin was 12.4 g/dl, total leukocyte count 12,300/cumm3, serum sodium 129 mEq/L, potassium 5 mEq/L, creatinine 2.6 mg/dl, corrected calcium 15.1 mg/dl, ionized calcium 1.75 mmol/L, phosphorus 3 mg/dl, and alkaline phosphatase 240 IU/L. His serum lipase was 77 U/L, amylase 24 U/L, and liver function tests were normal. Serum iPTH was 8.1 pg/ml (9–65), 25(OH)D 10 ng/ml, and 1,25(OH)2D 62.2 pg/ml (19.6–54.3). Based on clinical and biochemical profile, a diagnosis of PTH-independent hypercalcemia and pancreatitis was considered. There was no history of intake of lithium, thiazides, vitamin A, or D. Angiotensin-converting enzyme levels were normal and workup for multiple myeloma was noncontributory. Contrast-enhanced CT of chest and abdomen revealed hilar lymphadenopathy and bulky pancreas with multiple collections in the lesser sac. 18F-FDG-PET showed avid uptake in the mediastinal lymph nodes. Transbronchial lymph node biopsy was suggestive of sarcoidosis. The patient was managed with intravenous saline, diuretics, zoledronic acid 5 mg, and prednisolone 1 mg/kg/day. There was a rapid normalization of serum calcium levels within 3–4 days, and prednisolone was gradually tapered over a period of 6 months with sustained normalization of serum calcium during follow-up. Later, he was subjected to cystogastrostomy for pancreatic pseudocyst.

Keywords

Chronic Kidney Disease Serum Calcium Zoledronic Acid Primary Hyperparathyroidism Vascular Calcification 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Suggested Reading

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    Larry JL, De Groot LJ. Endocrinology: adult and pediatric. Philadelphia.: Elsevier Health Sciences; 2010.Google Scholar
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    Longo D, Anthony F, Dennis K, Stephen H, Jameson J, Joseph L. Harrison’s principles of internal medicine. 8th ed. New York: EB. McGraw Hill Professional; 2012.Google Scholar
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    Melmed S, Polonsky KS, Larsen PR, Kronenberg HM. Williams textbook of endocrinology: expert consult. London: Elsevier Health Sciences; 2011.Google Scholar

Copyright information

© Springer India 2015

Authors and Affiliations

  • Anil Bhansali
    • 1
  • Yashpal Gogate
    • 2
  1. 1.Department of EndocrinologyPostgraduate Institute of Medical Education and ResearchChandigarhIndia
  2. 2.Harmony Health HubNasikIndia

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