Chapter 26 Hypercalcemia in a 56-Year-Old Female (Case 15)
Endocrine Conditions | Malignancy | Exogenous Agents |
Primary hyperparathyroidism (PHPT) | Humoral | Thiazide diuretics |
Bone metastases | Lithium | |
Vitamin A | ||
Vitamin D |
PATIENT CARE
Clinical Thinking
• Primary HPT is due to autonomous PTH secretion despite hypercalcemia. This is typically due to a benign parathyroid adenoma, but can also be caused by parathyroid gland hyperplasia.
• Secondary HPT is due to PTH hypersecretion in response to hypocalcemia, hyperphosphatemia, and/or vitamin D deficiency. The most common cause of secondary HPT is chronic renal insufficiency, and you will usually identify these patients easily as they are on hemodialysis. Secondary HPTH does not cause hypercalcemia. (Calcium is usually low or normal.)
History
• Hx is directed at determining etiology. Although most patients seen today with hypercalcemia are asymptomatic, it is still useful to document any of the classical symptoms (“moans, stones, and groans”) related to the common target organs (CNS, renal, and bone).
• Is there a hx of malignancy or family hx of inherited endocrine disorder? (think multiple endocrine neoplasia syndromes)
Tests for Consideration
$12 | |
$5 | |
$60 | |
$165 | |
$75 | |
$25 | |
$45 |