Sudden onset of parathyroid hormone-independent severe hypercalcemia from reversal of tumoral calcinosis in a dialysis patient

Table 1 Trend in the patient’s calcium, phosphate, and PTH levels before and after cessation of alfacalcidol and switching to daily HD for treatment of her tumoral calcinosis

Serum biochemical marker	Three years before presentation (on PD)	At presentation before HD	One month after daily HD initiation	Two months after hospital discharge	Normal reference range
Calcium, mmol/L (mg/dL)^a	2.5 (10.1)	2.7 (11)	3.4 (14)^b	2.2 (8.8)	2.1–2.6 (8.4–10.4)
Phosphate, mmol/L (mg/dL)	1.5 (4.7)	2.0 (6.3)	1.3 (4.1)	1.4 (4.3)	0.8–1.5 (2.5–4.6)
Ca x P product, mmol²/L² (mg²/dL²)	3.9 (48)	5.6 (69)	4.4 (55)	3.1 (38)	^c
PTH, ng/L (pg/mL)	1062 (1062)	332 (332)	84 (84)	158 (158)	7–37 (7–37)

^aThese total calcium levels have been corrected for the serum albumin concentration
^bThe pre-discharge ionized calcium was also found to be elevated
^cProfessional guidelines have recommended a Ca x P product target of less than 4.4 mmol²/L² (55 mg²/dL²) in stages 3 to 5 CKD [11]

ISSN: 1471-2369