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Clinical Problem Solving
February 2014

Hypercalcemia in an Elderly Patient

Author Affiliations
  • 1Wake Forest School of Medicine, Winston-Salem, North Carolina
  • 2Wake Forest Baptist Health, Winston-Salem, North Carolina
JAMA Otolaryngol Head Neck Surg. 2014;140(2):169-170. doi:10.1001/jamaoto.2013.5796

A woman in her 70s was referred to the head and neck surgery service for evaluation and management of hyperparathyroidism. Laboratory tests revealed a total calcium level of 10.7 mg/dL (reference range, 8.5-10.5 mg/dL), an ionized calcium level of 1.39 mmol/L (1.00-1.30 mmol/L), and a parathyroid hormone (PTH) level of 184 pg/mL (12-72 pg/mL). Free thyroxine and thyroid-stimulating hormone (TSH) levels were within normal limits. A sestamibi scan demonstrated a focus of increased uptake of radiotracer adjacent to the inferior pole of the left lobe of the thyroid gland. At the time of consultation, the patient denied fatigue, abdominal pain, or urinary changes. Her only complaint was a frequent cramping of the lower extremities. Physical examination revealed no palpable masses or adenopathy. The patient was scheduled for parathyroid exploration. (To convert calcium to millimoles per liter, multiply by 0.025; to convert PTH to nanograms per liter, multiply by 1.)

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