Endocrine Abstracts

A 64-year-old woman presented acutely with dry cough, difficulty in eating, diarrhoea and weight loss. Her past medical history included cervical carcinoma in situ treated with laser therapy. She was found to be hypercalcaemic, with a corrected calcium of 2.84 mmol/l. During admission, the calcium ranged between 2.8-3.87 mmol/l. The PTH ranged between 0.2-0.4 pmol/l (1.3-9.3 pmol/l). She had raised inflammatory markers and deranged liver function tests. On review, she was mildly hypercalcaemic for 6 months prior to admission. Of note, she had a maculopapular rash on limbs and torso, which faded with time. An ulcerated lesion on her labia majora was diagnosed as lichen sclerosis secondary to urinary and faecal incontinence. During admission, her general health deteriorated rapidly. She became bedbound and doubly incontinent. Her myeloma screen was negative, and CT chest abdomen and pelvis only revealed patchy ground glass changes in lungs. A differential offered by the radiologist was COVID, which she tested negative. There was no evidence of solid tumours or lymphadenopathy. Her ACE levels were 111 (8-52) and 25(OH)2 Vitamin D levels were 63.4 nmol/l. The hypercalcaemia was refractory to bisphosphonates and calcitonin. Given the constellation of clinical features, an HIV test was performed, which was positive. Reports of non-parathyroid hypercalcaemia with HIV have been reported in the context of either antiretroviral therapy (immune reconstitution syndrome), tuberculosis or solid tumours. The finding of hypercalcaemia outside the above context in HIV is extremely rare. It is indeed possible that there may have been a solid tumour that was not detected on imaging or indeed sarcoidosis. However, her calcium was improving after commencing anti-retroviral therapy. Unfortunately, despite antiretroviral therapy and non-invasive ventilation, the patient died. It is likely that she was HIV positive for an extended period prior to this presentation.