TY - JOUR T1 - Hypercalcaemia, adrenal insufficiency and bilateral adrenal histoplasmosis in a middle-aged man: a diagnostic dilemma JF - BMJ Case Reports JO - BMJ Case Reports DO - 10.1136/bcr-2019-231142 VL - 12 IS - 8 SP - e231142 AU - Sweety Agrawal AU - Alpesh Goyal AU - Shipra Agarwal AU - Rajesh Khadgawat Y1 - 2019/08/01 UR - http://casereports.bmj.com/content/12/8/e231142.abstract N2 - 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. ER -