Changing Pattern of Hypercalcemia in a Hospital Setting – A Hospital Based Experience

Background: Hypercalcemia is a common metabolic abnormality of varying severity that can be adequately diagnosed and treated. Primary hyperparathyroidism and malignant neoplasms are responsible for >90% of all cases. Objectives: To study the clinical presentation and etiological profile of hypercalcemic patients at a district level hospital over a period of 24 months. The number of patients of hypercalcemia due to other rare cause like vitamin D intoxication have been increasing mainly due to over the counter supplementation. Methods: Forty patients, 22 males with a mean age of 50±10.2 and 18 females with mean age 45±7.6 with hypercalcemia were studied. The first step in evaluating hypercalcemia was confirming it first, with an initial evaluation including the measurement of intact parathyroid hormone , 25-hydroxy vitamin D levels and alongwith imaging wherever required. Results: Out of 40 patients studied, the most common clinical presentations were symptoms of aches and pains in 12 patients and incidental finding of hypercalcemia in 10 patients, altered sensorium in 6 patients. In etiological profile, the most common etiology was vitamin D intoxication in 10 patients followed by hyperparathyroidism in 9 patients and malignanacy in 7 patients respectively. Conclusion: In our study vitamin D intoxication (VDI) was the most common cause of hypercalcemia. as compared with multiple studies previously which showed malignancy and hyperparathyroidism as predominant causes. Inadvertent excessive use of pharmaceutical preparations is the most common etiology of exogenous vitamin D toxicity.

Etiologic Aspects of Hirsutism in Kashmiri Women Presenting to a District Hospital in Northern State of India

To assess the etiological aspects of hirsutism in Kashmiri women presenting to a district hospital in the northern state of India. Methods: Design: Prospective evaluation of hirsute patients referred to our endocrinology clinic. Setting: District-level primary care hospital. Patient(s): 150 consecutive women referred for hirsutism. Intervention(s): Assessment of body hair as per the Ferriman and Gallwey scoring system and an investi-gative protocol including detailed clinical assessment with endocrinologic workup including estimations of gonadotropins, PRL, T, and 17- hydroxyprogesterone and abdominopelvic ultrasound. Main Outcome Measure: Cause of hirsutism. Results: The etiology of hirsutism revealed idiopathic hirsutism in 35%, polycystic ovary syndrome (PCOS) in 35%, postmenopausal state in 12%, adrenal and ovarian tumors in 5 %, congenital adrenal hyperplasia in 2 %, and drug-induced hirsutism in 6 %. The cause remained undetermined in 5 % of patients for whom the available information was not adequate. Conclusion: Hirsutism is as common a problem in the Kashmir Valley (India) as elsewhere in the world. Idiopathic hirsutism (35 %), PCOS (35 %), and postmenopausal state ( 12 %) are common causes of hirsutism. Late-onset congenital adrenal hyperplasia is a relatively uncommon cause of hirsutism in the Kashmir Valley.