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Spontaneous rib fractures in a black woman with familial hypocalciuric hypercalcemia.
[familial hypocalciuric hypercalcemia]
Familial
hypocalciuric
hypercalcemia
(
FHH
)
is
a
rare
but
important
consideration
in
the
differential
diagnosis
of
hypercalcemia
.
FHH
results
from
an
autosomal
dominantly
inherited
inactivating
mutation
of
the
calcium
sensing
receptor
(
CaSR
)
gene
and
is
typically
associated
with
a
benign
clinical
course
and
normal
bone
mineral
density
.
We
describe
the
unusual
case
of
a
57
-
year
old
African
American
woman
with
spontaneous
rib
fractures
who
was
found
to
have
FHH
due
to
a
novel
set
of
polymorphisms
of
the
CaSR
gene
.
She
also
had
hypertension
,
esophageal
reflux
disease
treated
with
proton
pump
inhibitors
,
osteopenia
by
DEXA
scanning
,
and
a
prior
left
ankle
fracture
in
the
absence
of
significant
trauma
.
There
was
no
suggestive
family
history
and
her
only
sibling
had
a
normal
serum
calcium
.
The
patient
was
evaluated
extensively
for
potential
causes
of
osteoporotic
fractures
.
I
t
is
imperative
to
screen
for
FHH
using
24
-
hour
urinary
calcium
and
creatinine
excretion
in
subjects
with
hypercalcemia
irrespective
of
ethnicity
and
a
history
of
non-traumatic
rib
fractures
.
This
approach
may
prevent
unnecessary
neck
exploration
for
parathyroidectomy
which
is
unwarranted
in
FHH
.
Diseases
Validation
Diseases presenting
"hypercalcemia"
symptom
carcinoma of the gallbladder
cushing syndrome
familial hypocalciuric hypercalcemia
kabuki syndrome
severe combined immunodeficiency
waldenström macroglobulinemia
This symptom has already been validated