Abstract 14: Cause of PTH independent hypercalcemia other than malignancy and granulomatous disorders

Abstract

Case Report: We report cases of five patients. All females in the age group of 75 to 80 years. They presented to us in altered sensorium. Underlying comorbidities were hypertension and diabetes. After ruling out most probable diagnosis which was stroke, next differential was dyselectrolytemia. We found hypercalcemia in all the patients which was PTH independent with S. Calcium value >12 mg/dl. Prolonged intake of calcium and Vit D supplements was ruled out Keeping age in consideration, the most common differential of PTH independent hypercalcemia malignancy followed by granulomatous disease were ruled out in all the patients by doing PET CT/MR. Activated Vit D and ACE levels were also negative. No evidence of hyperthyroidism or adrenal insufficiency. We managed on the lines of acute hypercalcemia. 4 patients responded well and 1 continued to be in altered sensorium due to superadded sepsis. So excluding other causes, we had made an impression of uncommon cause of hypercalcemia which is immobilization. Although these females had not undergone any trauma. They were mostly bed bound. The pathophysiology of Immobilization related hypercalcemia (IH) is unclear. It is said that muscle activity transmits signal for bone formation through osteocytes and with immobility, mechanical stimulation is reduced, causing unopposed resorption.Conclusion: IH is an unknown complication in immobile patients. If untreated, patients can land up with complications of hypercalcemia.