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 12.8 mg/dL, a low-normal albumin level, a low-normal phosphorus level, and elevated alkaline phosphatase. Hypercalcemia workup reveals a suppressed parathyroid hormone, an elevated parathyroid hormone-related peptide (PTHrP), and a low-normal calcitriol (1,25-dihydroxyvitamin D) level.
Other presentations
Hypercalcemia of malignancy can occur with both solid and liquid tumors. Presenting symptoms are similar to those seen in hypercalcemia of any etiology. 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 hypercalcemia may be asymptomatic. Severe hypercalcemia may be associated with hypercalcemic crisis, with complications such as acute pancreatitis, acute kidney injury, and coma.[10]
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