HYPERCALCEMIA–WHAT IS THE ETIOLOGY

Case report prepared by of David Saxon, Vijay Shivasvamy, Ana Goncalves, and Ritu Madan

Case

34 yo otherwise healthy male is referred for fatigue, poor mood and anxiety. Review of systems is completely negative other than fatigue and mood complaints. He does not take any OTC medications. His examination is unremarkable. Routine labs show an elevated calcium  of 11.8 mg/dl with normal albumin levels of 4 mg/dl, BUN 20, creatinine 1.6

He is referred to endocrinology for further work up of hypercalcemia

Endocrine Workup

Endocrinologist orders more labs as shown below-

1. Calcium 11 mg/dl (8.3-10.6), albumin 4 mg/dl
2. Ionized calcium 6 mg/dl (4.8-5.7 mg/dl)
3. Phos : 3 mg/dl (2.5-4.5)
4. PTH- 8 pg/ml
5. 25-OH vitamin D- 46 ng/ml
6. 1,25-OH vitamin D- 140 pg/ml (10-75 pg/ml)
7. PTHrP- negative
8. 24 hr urine Calcium- 366 mg/day
9. Vitamin A levels- 70(18-77 mcg/dl)
10. TSH : 1.5 mcIU/ml
11. AM cortisol : 12 mcg/dl