Endocrine Abstracts

A 52-years man was admitted following a Road Traffic Accident.

He was a known smoker but usually fit and well. During the road traffic accident he sustained fracture of all four limbs, clavicles, facial bones as well as multiple rib fractures.

Following initial stabilisation in ITU he underwent multiple orthopaedic surgeries for his bony fractures over the next 2–3 months.

He was then noticed to have elevated corrected calcium of 3.04 mmol/l, phosphate 1.65 mmol/l and alkaline phosphate of 218 μ/l and referred to the endocrinologists.

A subsequent PTH was suppressed at 0.3 pmol/l (1.5–6.9).

A chest X-ray, serum immunoelectrophoresis, urine for Bence-Jones protein, TFT, 24-h urinary catecholamine levels and PTHrP were all normal.

A 0900 h cortisol was 291 nmol/l.

25 OH Vit D was 35 nmol/l.

He was treated with i.v. pamidronate and fluids for his hypercalcaemia and advised active mobilisation early.

On mobilisation his calcium levels stabilised to normal levels at 2.43 mmol/l and phosphate of 1.31 mmol/l.

Immobilisation is an unrecognised cause of hypercalcaemia and can occasionally cause quite elevated hypercalcaemia as in our case.

The hypercalcaemia was adequately managed with i.v. pamidronate and fluids.

Early mobilisation is the key to normalising calcium levels.