Life-Threatening Hypercalcemia due to Graves’ Disease and Concomitant Adrenal Failure: A Case Report and Review of the Literature

Table 1

Clinical and biochemical findings of the reported cases.

Case	A/S	TE	AFE	Ca-P-PTH; NR	(f)T3-(f)T4-TSH; NR	Cortisol-ACTH; NR	R
1	31/F	ST	LH	16.3 mg/dL-5.4 mg/dL-ND	ND/12 µg/dL/ND	ND-ND	[12]
				(8.5–9.7)-ND-ND	ND/(4–11)/ND	ND-ND
2	28/F	ST	LH	12.1 mg/dL-6.6 mg/dL-26 pg/mL	ND/20.2 µg/dL/ND	2 µg/dL-15 pg/mL	[13]
				(8.4–10.2)-(2.5–4.5)-(20–70)	ND/(5.0–11.5)/ND	ND-(0–23)
3	32/F	ST	LH	14.8 mg/dL-ND-ND	ND-14 µg/dL-<0.1	<2 µg/dL-24 pg/mL	[14]
				ND-ND-ND	ND-(5–12.5)-(0.5–6.0)	ND-(<120)
4	43/F	GD	AD	14.2 mg/dL-ND-ND	4.5 ng/mL-17.2 µg/dL-ND	<5 µg/dL-ND	[15]
				ND-ND-ND	(0.84–2.1)-ND-ND	ND-ND
5	29/F	ST	LH	3.12 mmol/L-0.73 mmol/L (0.75–1.35)-<1.5 mol/L	ND-30 pmol/L-0.2 mU/L	35 nmol/L-7 ng/L	[16]
				(2–2.5)-(0.75–1.35)-(1.6–6.9)	ND-(10–20)-ND	ND-(10–60)
6	41/F	ST	LH	12 mg/dL-ND-<1.5 pmol/L	1.95 pg/mL-1.76 ng/dL-<0.02 mU/L	1.5 µg/dL-ND	[17]
				ND-ND-(2–5)	(2.0–5.6)-(0.85–2.3)-(0.3–4.8)	ND-ND
7	54/M	GD	SHP	3.4 mmol/L-ND-ND	431//ND	ND-ND	[17]
				ND-ND-ND	(59–127)-(0.9–2.3)-ND	ND-ND
8	24/M	GD	SHP	13.2 mg/dL-5 mg/dL-<5 mg/dL	8.7 pg/mL-3.6 ng/dL-<0.1 mU/L	1.9 µg/dL-25.9 pg/mL	[4]
				(8.5–10.5)-ND-(10–65)	(2.2–4.5)-(0.7–1.8)-(0.35–4.0)	ND-ND
9	45/M	ST	LH	Ca: 3.56 mmol/L-1.51 mmol/L-<8 ng/L	7 nmol/L-75 ng/dL-<0.05 mU/L	50 nmol/L-10 ng/L	[18]
				ND-(0.75–1.35)-(10–65)	(1.0–2.6)-(8–27)-(0.15–3.5)	ND-ND
10	36/F	ST	LH	3.35 mmol/L-1.3 mmol/L-<0.5 µg/L	30 pmol/L-82 pmol/L-<0.03 mU/L	<3 nmol/L-1 pmol/L	[19]
				(2.2–2.56)-ND-ND	(3.8–6.6)-(12–25)-ND	ND-ND
11	64/F	IHH	IAD	3.29 mmol/L-1.78 mmol/L-0.9 pmol/L	6.2 pmol/L-20.1 pmol/L-0.01 mU/L	ND-ND	[7]
				(2.1–2.6)-(0.8–1.5)-(1.1–7.7)	(1–5.2)-(9–19)-ND	ND-ND
12	53/F	ST	UA	12.4 mg/dL-4.7 mg/dL-10 pg/mL	10.4 pg/mL-3.99 ng/dL-0.015 mU/L	8.8 µg/dL-23.3 pg/mL	[20]
				ND-ND-ND	(2.4–4.0)-(0.94–1.6)-(0.38–4.3)	ND-ND
13	32/M	ST	SHP	12 mg/dL-5.5 mg/dL-2 pg/mL	4.48 ng/mL-5.47 ng/dL-<0.01 mU/L	5.1 µg/dL-24.6 pg/mL	[21]
				(8.4–10.2)-(2.5–5.5)-(5–99)	(0.6–1.6)-(0.8–1.54)-(0.35–5.5)	ND-ND
PC	47/F	GD	BA	16 mg/dL-3.9 mg/dL-7.99 pg/mL	ND/7.7 ng/dL/0.005 mIU/L	0.533 µg/dL-ND
				(8.4–10.2)-(2.5–4.5)-(15–65)	ND/(0.93–1.7)/(0.4–4.2)	(5–23)-ND

A, age; S, sex; TE, thyrotoxicosis etiology; AFE, adrenal failure etiology; Ca, calcium; P, phosphorus; PTH, parathyroid hormone; NR, normal range; (f)T3, free or total triiodothyronine; (f)T4, free or total thyroxin; TSH, thyroid stimulating hormone; ACTH, adrenocorticotropic hormone; F, female; M, male; ST: silent thyroiditis; LH: lymphocytic hypophysitis; ND, not determined; GD, Grave’s disease; AD, Addison’s disease; SHP, secondary hypopituitarism; IHH, iodine induced hyperthyroidism; IAD, isolated ACTH deficiency; UA, unilateral adrenalectomy; PC, present case; BA, bilateral adrenalectomy.
Due to macroprolactinoma resection; free triiodothyronine index, free thyroxin index; due to hypothalamic tumor; due to ruptured Rathke’s cleft cyst.