Development of hypercalcemic crisis in a Graves' hyperthyroid patient associated with central diabetes insipidus

Intern Med. 1995 Sep;34(9):924-8. doi: 10.2169/internalmedicine.34.924.

Abstract

A 26-year-old man with Graves' hyperthyroidism associated with central diabetes insipidus (DI), initially showed hypercalcemic crisis. Initially, very low serum levels of intact parathyroid hormone (PTH) and 1,25-dihydroxy vitamin D3 and a moderate rise of serum C-terminal PTH related protein (C-PTHrP) were observed which strongly suggested a humoral hypercalcemia of malignancy due to PTHrP. However, the serum C-PTHrP level later became normal. Mild hyperprolactinemia, no responses of growth hormone (GH) to insulin-induced hypoglycemia despite a normal growth hormone releasing hormone (GRH) test and mild thickening of the pituitary stalk on magnetic resonance imaging were observed. Thus, an autoimmune nature of his central DI is considered; it is noteworthy that the serum C-PTHrP level may be elevated by renal failure in patients with hypercalcemia due to causes other than PTHrP.

Publication types

  • Case Reports

MeSH terms

  • Acute Disease
  • Adult
  • Diabetes Insipidus / blood
  • Diabetes Insipidus / complications*
  • Graves Disease / blood
  • Graves Disease / complications*
  • Humans
  • Hypercalcemia / blood
  • Hypercalcemia / etiology*
  • Male
  • Parathyroid Hormone / blood
  • Parathyroid Hormone-Related Protein
  • Proteins / metabolism

Substances

  • PTHLH protein, human
  • Parathyroid Hormone
  • Parathyroid Hormone-Related Protein
  • Proteins