Severe hypercalcaemia following cessation of hormone replacement therapy

Abstract

A 61-year-old female was admitted as an emergency with hypercalcaemia and acute kidney injury (AKI). She had a past medical history of: hypertension, and thyrotoxicosis requiring total thyroidectomy (1980). This procedure resulted in irreversible hypoparathyroidism requiring long-term treatment with calcium and vitamin D analogues. She had been commenced on hormone replacement therapy (HRT) in 1993 for post-menopausal symptoms. Her bone biochemistry and hypertension had been well controlled in the 5 years before admission with atenolol 25 mg/day; levothyroxine 75 mcg/day; alfacalcidol 2.25 mcg/day and sandocal 800 mg four times per day. Serum corrected calcium 13 months before admission had been 2.54 mmol/l (normal =2.15–2.6 mmol/l). At presentation she complained of headache, polydipsia and polyuria. Blood …