63 year old lady with abdominal pain and mild confusion

Samuel Wilson on May 26, 2013

Ms. Moore’s serum calcium level improves rapidly with the intravenous fluid hydration and is down to 10.1 on the next day. Now we can focus on identifying the cause of her hypercalcemia.

You begin by investigating the potential causes of hypercalcemia.

Taking into account the clinical picture and initial presentation, of the possible causes of hypercalcemia below, which one is the most likely?

Expand all answers
Primary Hyperparathyroidism
Incorrect, try again.


Secondary Hyperparathyroidism
Incorrect, try again.


Humoral hypercalcemia (PTH related protein) production
Approximately 80% of malignancies associated with hypercalcemia involves production of PTH related protein.


Osteoclastic bone resorption from bony metastasis
Only 20% of malignancies associated with hypercalcemia involve osteolytic hypercalcemia from metastases with cytokine production.


Considering her clinical picture, what is the most likely malignancy?

Expand all answers
Squamous cell lung carcinoma
Correct. Ms. Moore has a substantial smoking history that places her at greater risk for lung malignancies. Squamous cell lung carcinoma is frequently associated with production of the Parathyroid Hormone related protein (PTHrP) which leads to hypercalcemia.


Small cell lung carcinoma
Small cell lung carcinoma is typically associated with other paraneoplastic syndromes and is less likely to be associated with hypercalcemia.


Multiple myeloma
Multiple myeloma is characterized by hypercalcemia, renal failure, anemia, and bone involvement. She does not appear to have anemia or renal failure based on her comprehensive panel, making this possibility less likely.


Invasive ductal carcinoma
Incorrect. While breast cancer is a possibility, it is less likely given her presentation. Ms. Moore has a substantial smoking history that places her at greater risk for lung malignancies. Breast cancer typically causes hypercalcemia through osteoclastic bone resorption from bony metastasis. It is unlikely she has metastatic disease without any prior history of primary breast cancer.


Ms. Moore’s serum calcium level improves rapidly with the intravenous fluid hydration and is down to 10.1 on the next day. Now we can focus on identifying the cause of her hypercalcemia.

You begin by investigating the potential causes of hypercalcemia.

Taking into account the clinical picture and initial presentation, of the possible causes of hypercalcemia below, which one is the most likely?

Expand all answers
Primary Hyperparathyroidism
Incorrect, try again.


Secondary Hyperparathyroidism
Incorrect, try again.


Humoral hypercalcemia (PTH related protein) production
Approximately 80% of malignancies associated with hypercalcemia involves production of PTH related protein.


Osteoclastic bone resorption from bony metastasis
Only 20% of malignancies associated with hypercalcemia involve osteolytic hypercalcemia from metastases with cytokine production.


Considering her clinical picture, what is the most likely malignancy?

Expand all answers
Squamous cell lung carcinoma
Correct. Ms. Moore has a substantial smoking history that places her at greater risk for lung malignancies. Squamous cell lung carcinoma is frequently associated with production of the Parathyroid Hormone related protein (PTHrP) which leads to hypercalcemia.


Small cell lung carcinoma
Small cell lung carcinoma is typically associated with other paraneoplastic syndromes and is less likely to be associated with hypercalcemia.


Multiple myeloma
Multiple myeloma is characterized by hypercalcemia, renal failure, anemia, and bone involvement. She does not appear to have anemia or renal failure based on her comprehensive panel, making this possibility less likely.


Invasive ductal carcinoma
Incorrect. While breast cancer is a possibility, it is less likely given her presentation. Ms. Moore has a substantial smoking history that places her at greater risk for lung malignancies. Breast cancer typically causes hypercalcemia through osteoclastic bone resorption from bony metastasis. It is unlikely she has metastatic disease without any prior history of primary breast cancer.


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