Endocrine Abstracts

Introduction: Immobilization hypercalcemia is uncommon condition associated with limited movements following brain and spinal cord lesions. Immobilization results in stimulation of osteoclastic bone resorption hypercalciuria and hypercalcemia.

Case report: 57 year female, Background of Breast Cancer (Treated with Skin sparing mastectomy and adjuvant radiotherapy) admitted following large subdural hematoma leading to craniotomy and evacuation of hematoma. Postoperative period was complicated with pneumonia and Gastric ulcer perforation requiring laparotomy. She had prolonged Hospital stay, initially in ITU and then Neurorehabilitation unit. Six weeks following admission, she was noted to have raised Corrected calcium (2.77 mmol/l) with suppressed PTH (0.8 pmol/l). Phosphate was normal with slightly elevated alkaline phosphatase. Hypercalcemia was acute and noted following 6 weeks of immobility. Bone profile was normal on admission. Calcium levels continued to rise to reach the level of 3.03 mmol/l. She had extensive investigations in the form of imaging and tumor markers and no evidence of occult malignancy or recurrence of breast cancer was found. Vitamin D levels were adequate. Urine calcium excretion was raised (12.13 mmol/24 hour). Thyroid and adrenal functions were normal. She was not on any drugs to cause hypercalcemia. Multiple myeloma was excluded with serum and urine electrophoresis and bone marrow biopsy (No evidence of plasma cell myeloma Multiple myeloma). Diagnosis of hypercalcemia due to immobility was established and she was treated with fluid replacement and Zoledronic acid infusion. Calcium level normalized 2 days later and remained normal when mobilization commenced the following week. The patient has been followed up and there has been no evidence of recurrence of hypercalcemia.

Discussion: Albright described immobilization-associated hypercalcemia in 1941. Hypercalcemia immobilization should be accounted for in patients with immobilization and hypercalcemia. It requires extensive evaluation to rule out other more likely hypercalcemia causes. The patients with sepsis or with reduced Glomerular filtration rate are at increased risk.