Hypercalcemia caused by comorbid parathyroid adenoma and pulmonary tuberculosis

Abstract

Hypercalcemia is usually secondary to one etiology, although two coexisting etiologies can rarely cause hypercalcemia. Here, we report a 47-year-old woman with hypercalcemia caused by comorbid parathyroid adenoma and pulmonary tuberculosis. Primary hyperparathyroidism is the most common cause of hypercalcemia. Tuberculosis is a rare cause of hypercalcemia, but Japan continues to have an intermediate tuberculosis burden. Therefore, tuberculosis should be considered as a cause of hypercalcemia in Japan. Patients with tuberculosis are often asymptomatic, making the diagnosis difficult. In the previous cases in which these diseases coexisted, one disease was diagnosed after treatment of the other. In our case, the very high 1,25-dihydroxyvitamin D level (162 pg/mL) helped us to diagnose asymptomatic tuberculosis and both diseases were diagnosed promptly. It is necessary to consider comorbidities, including tuberculosis in a case with a very high 1,25-dihydroxyvitamin D level. We report a valuable case in which the early diagnosis and treatment of tuberculosis and primary hyperparathyroidism prevented the spread of tuberculosis.

Keywords: 1,25-Dihydroxyvitamin D; Hypercalcemia; Primary hyperparathyroidism; Tuberculosis.

Fig. 1

a The chest X-ray findings were normal. b Chest computed tomography scan shows multiple nodular shadows (dotted circle) in both lungs

Fig. 2

The clinical course of the patient. HREZ H: isoniazid + R: rifampicin + E: ethambutol + Z: pyrazinamide, HR H: isoniazid + R: rifampicin, T-score T-score of femoral neck bone mineral density