Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, Japan.
CEN Case Rep. 2021 Feb;10(1):1-5. doi: 10.1007/s13730-020-00509-2. Epub 2020 Jul 6.
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.
高钙血症通常是继发于单一病因，尽管两种共存病因很少引起高钙血症。在此，我们报告一例 47 岁女性，因甲状旁腺腺瘤和肺结核合并存在而发生高钙血症。原发性甲状旁腺功能亢进症是高钙血症最常见的原因。结核病是引起高钙血症的罕见原因，但日本仍有中等结核病负担。因此，在日本，结核病应被视为高钙血症的一个病因。结核病患者常无症状，使诊断变得困难。在以前这些疾病共存的病例中，一种疾病在治疗另一种疾病后得到诊断。在我们的病例中，非常高的 1,25-二羟维生素 D 水平（162 pg/mL）帮助我们诊断了无症状性肺结核，两种疾病均得到了及时诊断。在血钙水平非常高的病例中，需要考虑包括结核病在内的合并症。我们报告了一个有价值的病例，该病例及时诊断和治疗肺结核和原发性甲状旁腺功能亢进症，防止了结核病的传播。
