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CASE REPORT
Hypercalcaemia, adrenal insufficiency and bilateral adrenal histoplasmosis in a middle-aged man: a diagnostic dilemma
  1. Sweety Agrawal1,
  2. Alpesh Goyal2,
  3. Shipra Agarwal3 and
  4. Rajesh Khadgawat2
  1. 1 Endocrinology, Max Healthcare, Saket, New Delhi, India
  2. 2 Endocrinology, All India Institute of Medical Sciences, New Delhi, India
  3. 3 Pathology, All India Institute of Medical Sciences, New Delhi, India
  1. Correspondence to Dr Alpesh Goyal, alpeshgoyal89{at}gmail.com

Abstract

A 45-year-old man presented with a 3-month history of involuntary weight loss, anorexia, postural dizziness and intermittent fever. On investigation, he was found to have parathyroid hormone (PTH)-independent hypercalcaemia, with negative workup for 25-hydroxyvitamin D or 1,25-dihydroxyvitamin D excess, thyrotoxicosis, multiple myeloma and bony metastases. On further evaluation, he was detected to have primary hypoadrenalism with bilateral adrenal enlargement, secondary to adrenal histoplasmosis. Hypercalcaemia improved with hydration and physiological steroid replacement even before initiation of antifungal therapy, confirming adrenal insufficiency as the cause for hypercalcaemia. Hypercalcaemia resulting from hypoadrenalism secondary to adrenal histoplasmosis is rare and should be suspected whenever evaluating a patient with PTH-independent hypercalcaemia.

  • infections
  • adrenal disorders
  • calcium and bone
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Footnotes

  • Contributors SwA, AG and RK were involved in clinical care and management of the patient. SwA and AG reviewed the literature and prepared the initial draft of the manuscript with valuable intellectual inputs from RK. ShA helped with the histopathological diagnosis. All authors read and approved the final version of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.

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