Primary Hyperparathyroidism Masquerading as Immobilization Hypercalcemia: Report of an Illustrative Case

We report a male who exhibited the Landry-Guillain-Barré syndrome and hypercalcemia. He initially exhibited normocalcemia, followed by hypercalcemia which developed during tetraplegi a and the recovering phase of the syndrome. The administration of prednisolone, saline, calcitonin, etidronate, and i...

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Bibliographic Details
Published in:Endocrine Journal 1993, Vol.40(1), pp.35-39
Main Authors: MONNO, SATOSHI, YOKOZAWA, TAMOTSU, MIZUSHIMA, YUTAKA, NAKAYAMA, JUN, OHGAKU, SEIJI, KATO, HIROMI, TAKASU, NOBUUKI, KOBAYASHI, MASASHI
Format: Article
Language:English
Subjects:
Adenoma - complications
Adenoma - pathology
Adult
Calcium - blood
Creatinine - blood
Diagnosis, Differential
Humans
Hypercalcemia
Hypercalcemia - diagnosis
Hypercalcemia - metabolism
Hyperparathyroidism
Hyperparathyroidism - diagnosis
Hyperparathyroidism - metabolism
Immobilization
Immobilization - adverse effects
Immunoradiometric Assay
Male
Parathyroid Hormone - blood
Parathyroid hormone assay
Parathyroid Neoplasms - complications
Parathyroid Neoplasms - pathology
Polyradiculoneuropathy - diagnosis
Polyradiculoneuropathy - metabolism
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Summary:We report a male who exhibited the Landry-Guillain-Barré syndrome and hypercalcemia. He initially exhibited normocalcemia, followed by hypercalcemia which developed during tetraplegi a and the recovering phase of the syndrome. The administration of prednisolone, saline, calcitonin, etidronate, and indomethacin failed to normalize the serum calcium level. Since, with mobilization, the serum calcium level gradually became normal, the calcium abnormality was misdiagnosed as immobilization hypercalcemia. However, among 6 different parathyroid hormone (PTH) assays used, including a two-site immunoradiometric assay, only a mid-region specific PTH (mPTH) assay showed high levels in both hypercalcemic and normocalcemic periods, and a high level of mPTH was not suppressed by calcium infusion in the normocalcemic period. Neck exploration disclosed a parathyroid adenoma weighed 100mg. This case illustrates the hypercalcemia-inducing effect of immobilization on mild type primary hyperparathyroidism. A high level mPTH assay, its unsuppressibility by the calcium infusion test, and ineffectiveness of oral etidronate for hypercalcemia were valuable in differentiating hypercalcemia due to primary hyperparathyroidism from that resulting solely from prolonged immobilization.
ISSN:0918-8959
1348-4540
DOI:10.1507/endocrj.40.35