Endocrine Abstracts

Introduction: Hypercalcemia is uncommon in patients with adrenal insufficiency. It is common in patients with primary hyperparathyroidism and malignancy.

Case: This is a case of primary adrenal insufficiency presenting as acute kidney injury and hypercalcemia. The patient was referred with 10 days history of vomiting, decreased appetite, lethargy and abdominal pain. A week before admission, she developed pleuritic chest pain worsening with inspiration. Her admission bloods showed acute kidney injury (eGFR 38 ml/min), hyponatremia (121 mmol/l), hyperkalaemia (5.7 mmol/l), and hypercalcemia (3.11 mmol/l). Workup for primary hyperparathyroidism and screening for malignancy were negative. Basal cortisol was undetectable (<30 nmol/l) and adrenocorticotrophic hormone level was raised (1030 ng/l). Administration of hydrocortisone and intravenous fluids resulted in dramatic resolution of hypercalcemia and electrolyte abnormalities within 48 h.

Conclusion: This case shows that adrenal insufficiency can may present with hypercalcemia and acute kidney injury and should be considered while evaluating cause of hypercalcemia in patient especially if investigations for common causes are negative.