A rare metabolic complication: hypercalcemic crisis in a patient using a GLP-1 agonist

Abstract

Hypercalcemic crisis is a rare complication of markedly elevated serum calcium levels and most commonly occurs in patients with paraneoplastic syndrome or primary hyperparathyroidism.1 We present the case of a hypercalcemic crisis in a 54-year-old woman who was recently started on semaglutide while also taking a thiazide diuretic. After ruling out other potential causes by measuring parathyroid hormone (PTH), parathyroid hormone–related protein (PTHrP), 1,25-dihydroxy vitamin D, and 25-hydroxy vitamin D levels, it was determined that dehydration from inadequate fluid intake in the setting of semaglutide therapy, combined with increased serum calcium levels associated with thiazide diuretic use, precipitated a hypercalcemic crisis in this patient.

Keywords: Hypercalcemic crisis, GLP-1 agonists, paraneoplastic syndrome, primary hyperparathyroidism