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Clinical Challenge
March 2017

A Young Man With Hypercalcemia

Author Affiliations
  • 1Department of Otolaryngology–Head and Neck Surgery, University of Michigan Medical School, Ann Arbor
JAMA Otolaryngol Head Neck Surg. 2017;143(3):311-312. doi:10.1001/jamaoto.2016.2737

A well-developed man in his 20s presented to our hospital with a clinically significant elevation in serum calcium level to (14.1 mg/dL [reference range, 8.6-10.2 mg/dL]) found on routine laboratory tests. He was highly functional and denied abdominal pain, dysuria, anxiety, lethargy, and constipation. Findings from his physical examination were within normal limits. He did not have any palpable thyroid nodules or cervical lymphadenopathy. Given his elevated calcium level, parathyroid hormone (PTH) was drawn, and results returned significantly elevated at 1377 pg/mL (reference range, 10-65 pg/mL). Because of the extremely elevated PTH level, a technetium Tc 99m sestamibi single-photon emission computed tomographic/computed tomographic (SPECT/CT) scan was obtained, which identified a lesion in the location of the right inferior parathyroid gland, measured at 2.2 cm (Figure, A). In addition, CT showed associated lytic bone lesions of the left mandibular ramus, left scapula, and C5 vertebra (Figure, B).

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