Case of the Month: Mineral Metabolism & Cancer

endocrine board review

This issue highlights the 8th edition of EBR – a mock-exam with more than 240 clinical case questions. Hear expert commentary and read in-depth answer rationales. Available on the online store.

A 34-year-old woman presents with nausea, vomiting, mental confusion, and dehydration. Her history is positive for a Wilms tumor as a child and uterine fibroids. Both her mother and older brother have a history of primary hyperparathyroidism and a maternal aunt had a benign fibroma removed from her mandible.

On physical examination, the patient is lethargic and disoriented with a 3-cm firm mass on the left side of the neck that moves with swallowing.

Laboratory test results:

  • Serum calcium = 16 mg/dL (4.0 mmol/L) (reference range, 8.2-10.2 mg/dL [2.1-2.6 mmol/L])
  • Intact PTH = 750 pg/mL (750 ng/L) (reference range, 10-65 pg/mL [10-65 ng/L])
  • Creatinine = 2.2 mg/dL (194.5 μmol/L) (reference range, 0.6-1.1 mg/dL [53.0-97.2 µmol/L])
  • Phosphorus = 3.0 mg/dL (1.0 mmol/L) (reference range, 2.3-4.7 mg/dL [0.7-1.5 mmol/L])

Which of the following is the most likely etiology of this patient’s hypercalcemia?

  1. Familial hypocalciuric hypercalcemia complicated by renal failure
  2. Multiple endocrine neoplasia type 4
  3. Parathyroid carcinoma
  4. Thyroid cancer with coincident primary hyperparathyroidism
  5. Acute hemorrhage into a parathyroid adenoma


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