Secondary hyperparathyroidism and symptomatic hypercalcemia: overlooked complications of chronic liver disease

Secondary hyperparathyroidism and symptomatic hypercalcemia: overlooked complications of chronic liver disease

Hoilat JN1*, Hoilat GJ2, Kadan S3, Emanuele MA1

1Loyola University Medical Center, 2SUNY upstate medical center, 3Alfaisal University college of medicine

A 71-year-old female with biopsy-proven liver cirrhosis was brought to the ER due to confusion for 5 days. She was diagnosed with acute decompensated liver disease and hepatic encephalopathy. Investigations also revealed PTH-dependent hypercalcemia. Both of these entities could be causing her symptoms. Neck ultrasound did not reveal any parathyroid lesions. Alteration in mental status persisted even after the management and resolution of hepatic encephalopathy. Symptomatic resolution occurred after normalization of her calcium levels which required normal saline, cinacalcet as well as calcitonin over the course of 7 days. Hypercalcemia secondary to chronic liver disease should be considered in the differential diagnosis of patients with liver cirrhosis presenting with an altered mental status. Hypercalcemia of chronic liver disease is not always transient and managed with normal saline as previously reported; It could necessitate more aggressive therapy with calcitonin and cinacalcet as reported in this case.

Keywords: Chronic liver disease; Case report

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Hoilat JN, Hoilat GJ, Kadan S, Emanuele MA. Secondary hyperparathyroidism and symptomatic hypercalcemia: overlooked complications of chronic liver disease. International Journal of Case Reports, 2020; 4:175. DOI: 10.28933/ijcr-2020-10-2605


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