Adrenal insufficiency presenting as hypercalcemia and acute kidney injury

Figures & data

Table 1 Laboratory data on admission and 2 weeks before

Variable	Reference range	On admission	Two weeks before
Hematocrit (%)	40.0–48.0	39.7	34.4
Hemoglobin (g/dL)	13.0–18.0	13.7	11.7
White cell count (10^9/L)	4.0–10.0	13.0	6.71
Differential count (%)
Neutrophils	45–75	36.0	39.2
Lymphocytes	20–50	39.6	41.6
Monocytes	2–9	17.5	11.6
Eosinophils	0–5	5.5	6.6
Basophils	0–2	1.4	1.0
Platelet (10^9/L)	140–450	350	530
Sodium (mmol/L)	135–145	132	140
Potassium (mmol/L)	3.5–5.5	3.4	3.5
Chloride (mmol/L)	98–110	96	105
Urea nitrogen (mg/dL)	6.0–20.0	37.9	13.0
Creatinine (mg/dL)	0.68–1.30	4.9	0.6
MDRD-GFR (mL/minutes/1.73 m^2)		9.66	93.64
Calcium (mg/dL)	8.6–10.2	11.5	9.4
Phosphorus (mg/dL)	2.7–4.5	3.6	4.1
Magnesium (mg/dL)	1.6–2.6	1.6	2.0
Total bilirubin (mg/dL)	<1.0	1.0	0.6
Aspartate aminotransferase (U/L)	0–40	20	13
Alanine aminotransferase (U/L)	0–40	16	16
Total protein (g/dL)	6.6–8.7	5.9	6.0
Albumin (g/dL)	3.4–4.8	2.8	2.9
Urinalysis
Specific gravity	1.003–1.030	1.016
pH	4.8–7.5	5.0
Protein	Negative	Negative
Glucose	Negative	Negative
Ketone	Negative	Negative
Nitrite	Negative	Negative
Bilirubin	Negative	Negative
Blood	Negative	Negative
Microscopic white blood cell	0–3/HPF	20–29/HPF
Microscopic red blood cell	0–1/HPF	5–9/HPF
Epithelial cell	0–1/HPF	1–4/HPF
Urine bacteria	Negative	Some

Abbreviations: HPF, high power field; MDRD-GFR, modification of diet in renal disease–glomerular filtration rate.

Figure 1 Clinical course of serum calcium, magnesium, and creatinine level.

Table 2 The ACTH stimulation test

Time (minutes)	0	30	60	90	120
Cortisol (μg/dL)	2.36	9.37	11.43	12.85	10.21

Note: Cortisol reference range (6.7–22.6 μg/dL).

Abbreviation: ACTH, adrenocorticotropic hormone.