Mohammad Khaledi
1, Rezvan Salehidoost
1, Mohammadreza Khosravifarsani
2 
, Ashraf Aminorroaya
1*1 Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
2 Cancer Prevention Research Center, Isfahan University of medical sciences, Isfahan, Iran
Abstract
Here in this paper, we present a 60-year-old man admitted for generalized pain in his limbs
and was finally diagnosed with multiple myeloma. He also underwent evaluation and
treatments for his hypercalcemia (15 mg/dL). His calcium concentration did not respond well
to different modalities and was along with a low parathyroid hormone (PTH) and elevated
creatinine concentration (12 mg/dL). Further evaluations revealed normal ionized calcium
which confirmed the diagnosis of pseudohypercalcemia. Multiple myeloma is a plasma cell
neoplasm in which 10% of the patients suffer from true-hypercalcemia at the time of diagnosis.
Pseudohypercalcemia is described as an elevated serum calcium concentration along with
normal ionized calcium concentration and the absence of clinical symptoms of hypercalcemia.
The cause of pseudohypercalcemia in multiple myeloma is due to the binding of calcium to
increased abnormal immunoglobulins. The importance of this issue lies in the low PTH levels
along with hypercalcemia and azotemia which is suggestive of pseudohypercalcemia.
Implication for health policy/practice/research/medical education:
Physicians must be careful and aware of pseudohypercalcemia in patients with multiple myeloma who have low PTH level
despite renal failure. In such situations, ionized calcium concentration is suggested to be measured at the first step to prevent
unnecessary treatments.
Please cite this paper as: Khaledi M, Salehidoost R Khosravifarsani M, Aminorroaya A. Pseudohypercalcemia in a patient with
multiple myeloma and acute kidney injury; a case report. J Nephropharmacol. 2019;8(2):e15. DOI: 10.15171/npj.2019.15