Endocrine Abstracts

Background: The initial management of hypercalcaemia is well described: aggressive intravenous rehydration and subsequent intravenous bisphosphonates if required. Isolated case reports document the use of haemo/peritoneal dialysis and haemofiltration in the management of severe hypercalcaemia. We report three cases that required renal replacement therapy to treat severe hypercalcaemia.

Case series: A 21-year-old male presented with abdominal pain and vomiting. He was found to be hypercalcaemic (corrected calcium 5.00 mmol/l). A CT scan revealed pancreatitis. Parathyroid hormone (PTH) was 900 ng/l. He was promptly treated with intravenous fluids, pamidronate, calcitonin and haemofiltration to rapidly reduce his calcium level to excellent effect. He proceeded to urgent surgery; histology confirmed a 5×3 cm adenoma.

A 73-year-old female presented with a swollen leg secondary to deep vein thrombosis. Routine bloods revealed corrected calcium of 4.76 mmol/l (previously normal), and acute kidney injury (creatinine 478 μmol/l). Aggressive rehydration was delayed and after 24 h she required urgent haemodialysis to reduce her calcium level and control her fluid balance. PTH was 1644 ng/l. Urgent parathyroidectomy was performed; histology confirmed a dominant nodule on the background of hyperplasia. Renal function recovered after 16 days.

A 33-year-old male with known X-linked hypophosphataemia on long-term calcitriol and oral phosphate presented with a short history of nausea, vomiting and constipation. Corrected calcium was 4.61 mmol/l. He was treated with intravenous fluids, pamidronate, and the calcitriol was stopped. He represented 3 weeks later with similar symptoms and hypercalcaemia (3.8 mmol/l). PTH was 676 ng/l. Cinacalcet was started but seven days later he required haemodialysis for recurrent hypercalcaemia. He underwent urgent parathyroid surgery; histology confirmed four gland hyperplasia.

Conclusions: This series highlights the important role of renal replacement therapy in the management of severe hypercalcaemia: in medical optimisation for urgent parathyroid surgery, in the presence of direct complications of the profound hypercalcaemia, or in treatment resistant cases.

DOI: 10.1530/endoabs.31.P22