Milk-Alkali Syndrome: A Century Old Cause of Resurgence of Severe Hypercalcemia Due to Excessive Use of Calcium Supplements

The milk-alkali syndrome (MAS) is characterized by a triad of elevated calcium levels, metabolic alkalosis and acute kidney injury that commonly occurs due to the combined intake of large amounts of calcium and absorbable alkali. The syndrome can have an acute onset with the rapid development of hypercalcemia and, if left untreated, may result in acute renal failure and metastatic calcification. An increased number of cases of MAS have recently been reported. This is likely due to the common use of over the counter (OTC) preparations of calcium for preventing and treating osteoporosis in postmenopausal women. Herein, we report a case of severe hypercalcemia due to prolonged intake of calcium carbonate supplements in the absence of any alkali.

Recurrent NSAIDs-induced Hypoglycemia in a Nondiabetic Patient

Hypoglycemia is defined by a low blood glucose level associated with clinical symptoms. Hypoglycemia may be related to treatment of diabetes, but also to drugs, alcohol, critical illness, cortisol insufficiency including hypopituitarism, insulinoma, bariatric or gastric surgery, pancreas transplantation or glucagon deficiency, or may be surreptitious. Some hypoglycemic episodes remain unexplained, and a proper drug history should be sought. Though various drugs have been implicated as a cause of hypoglycemia; herein, we report a case of recurrent nonsteroidal anti-inflammatory drugs (NSAIDs)-induced hypoglycemia in a nondiabetic patient.

Pheochromocytoma: The Great Masquerader

Catecholamine-secreting tumors occur with equal frequency in men and women, primarily in the fourth and fifth decades. The associated hypertension may be sustained or paroxysmal, and patients who are diagnosed in the presymptomatic stage may have normal blood pressure. These tumors can be lethal unless they are diagnosed early and treated appropriately. Numerous disorders can mimic pheochromocytoma, leading to diagnostic dilemma. Described here is a case which was misdiagnosed for 5 years as anxiety, panic attacks, cervical spondylosis, vasomotor symptoms of menopause, arrhythmia and even acute coronary syndrome. Therefore, enhanced adrenal awareness is the need of the hour, to catch this “great masquerade”.