Case history
Case history
A 63-year-old woman is brought in by her family for progressive fatigue and confusion. Past medical history is notable for ovarian cancer. Physical examination reveals dry mucous membranes. Admission labs are significant for an elevated adjusted serum calcium of 3.2 mmol/L (12.8 mg/dL), a low-normal albumin level, a low-normal phosphorus level, and elevated alkaline phosphatase. Hypercalcaemia work-up reveals a suppressed parathyroid hormone, an elevated parathyroid hormone-related peptide (PTHrP), and a low-normal calcitriol (1,25-dihydroxyvitamin D) level.
Other presentations
Hypercalcaemia of malignancy can occur with both solid and liquid tumours. Presenting symptoms are similar to those seen in hypercalcaemia of any aetiology. Symptoms include neuropsychiatric changes (mood disturbance, fatigue, confusion, stupor, and coma), gastrointestinal disturbance (loss of appetite, nausea, constipation), muscle weakness, acute kidney injury, polyuria, polydipsia, and bone pain.[1][5][13] Mild hypercalcaemia may be asymptomatic. Severe hypercalcaemia may be associated with hypercalcaemic crisis, with complications such as acute pancreatitis, acute kidney injury, and coma.[10]
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