Hypercalcemic Patient Diagnosed With Primary Hyperparathyroidism After Dapagliflozin Treatment

Pınar Akhanlı, MD; Sema Hepsen, MD; Bekir Ucan, MD; Güleser Saylam, MD; Erman Cakal, MD

AACE Clinical Case Reports (Nov 2020)

Hypercalcemic Patient Diagnosed With Primary Hyperparathyroidism After Dapagliflozin Treatment

Pınar Akhanlı, MD,
Sema Hepsen, MD,
Bekir Ucan, MD,
Güleser Saylam, MD,
Erman Cakal, MD

Affiliations

Pınar Akhanlı, MD: Address correspondence to Dr. Pınar Akhanlı, Ziraat Mahallesi, Şehit Ömer Halisdemir Cad., 06110 Dışkapi, Altındağ/Altındağ/Ankara.; From the University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Department of Endocrinology and Metabolism, Ankara, Turkey
Sema Hepsen, MD: From the University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Department of Endocrinology and Metabolism, Ankara, Turkey
Bekir Ucan, MD: From the University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Department of Endocrinology and Metabolism, Ankara, Turkey
Güleser Saylam, MD: University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Department of Otolaryngology and Head and Neck Surgery, Ankara, Turkey.
Erman Cakal, MD: From the University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Department of Endocrinology and Metabolism, Ankara, Turkey

Journal volume & issue: Vol. 6, no. 6
pp. e319 – e321

Abstract

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ABSTRACT: Objective: Hypercalcemia associated with the use of sodium-glucose transporter-2 (SGLT-2) inhibitors is very rare. Only 2 cases have been reported in the current literature. In these cases hypercalcemia occurred with the use of SGLT-2 inhibitors taken with thiazides and excessive calcium salts. We present a case of hypercalcemia and primary hyperparathyroidism diagnosed after dapagliflozin treatment. Methods: We describe the medical history, laboratory test results, parathyroid ultrasound, 4-dimensional computed tomography-magnetic resonance imaging, and histopathology findings of the patient. Results: A 49-year-old man with 5-year history of type 2 diabetes mellitus was found to have hypercalcemia with corrected calcium of 11.28 mg/dL (reference range [RR] is 8.8 to 10.6 mg/dL) 6 months after starting dapagliflozin. Previous records showed normocalcemia for many years. Parathyroid hormone level was 70.8 pg/mL (RR is 15 to 65 pg/mL) and 24-hour urinary calcium excretion level was 492 mg/day (RR is 100 to 300 mg/day). On parathyroid ultrasound, a 4 × 9 × 14-mm hypoechoic lesion inferior to the right thyroid lobe was detected. A 15 × 10 × 9-mm oval lesion was observed in the right paratracheal area. A lesion at T1 vertebra level was also seen on 4-dimensional computed tomography-magnetic resonance imaging. The patient underwent lower right parathyroidectomy. Histopathology confirmed the diagnosis of parathyroid adenoma. The patient was asymptomatic 3 months after the operation with a normal corrected calcium level of 9.2 mg/dL. Conclusions: SGLT-2 inhibitors could have unmasked an underlying mild hyperparathyroidism, as they can increase predisposition to hypercalcemia when used with medications causing it. Volume depletion caused by SGLT-2 inhibitors may also contribute to hypercalcemia. For these reasons, calcium levels should be monitored in patients taking SGLT-2 inhibitors. Abbreviations: FGF-23 fibroblast growth factor-23 PTH parathyroid hormone RR reference range SGLT-2 sodium-glucose transporter-2

Published in AACE Clinical Case Reports

ISSN: 2376-0605 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Diseases of the endocrine glands. Clinical endocrinology
Website: https://www.journals.elsevier.com/aace-clinical-case-reports

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