Endocrine Abstracts

A 74-year-old with a history of type 2 diabetes, chronic kidney disease, vitamin D deficiency and bronchiectasis was referred to the medical team with symptomatic hypercalcaemia with raised adjusted calcium of 3.80 mmol/l. Investigations also showed raised creatinine and vitamin D levels; normal parathyroid hormone (PTH) and angiotensin-converting enzyme (ACE). Myeloma screen was negative. A diagnosis of primary hyperparathyroidism was made in view of elevated calcium and normal PTH levels. On this admission, vitamin D supplements were stopped and she was treated with intravenous fluids and pamidronate. In the following weeks, CT and bone scan did not show any evidence of malignancy and there was no increased uptake on sistamibi scan. PTH-related peptide levels were not detected. Hypercalcaemia persisted despite cinacalcet, IV pamidronate and post-parathyroidectomy of all four glands. She was treated empirically with dexamethasone in view of malignancy being a differential diagnosis. PET-CT showed extensive lymphadenopathy of supraclavicular, mediastinal and hilar nodes. A biopsy was undertaken via endoscopic bronchial ultrasound (EBUS) revealed lymphocytes, a single epitheloid and giant cell granuloma. This confirms a diagnosis sarcoidosis with secondary hypercalcaemia.