Pellicciotti F, Giusti A, Gelli MC, Foderaro S, Ferrari A, Pioli G. Challenges in the differential diagnosis of hypercalcemia: A case of hypercalcemia with normal PTH level. World J Clin Oncol 2012; 3(1): 7-11 [PMID: 22247823 DOI: 10.5306/wjco.v3.i1.7]
Corresponding Author of This Article
Giulio Pioli, MD, Geriatric Unit, Arcispedale Santa Maria Nuova, Viale Risorgimento 80, 42123 Reggio Emilia, Italy. giulio.pioli@asmn.re.it
Article-Type of This Article
Case Report
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World J Clin Oncol. Jan 10, 2012; 3(1): 7-11 Published online Jan 10, 2012. doi: 10.5306/wjco.v3.i1.7
Challenges in the differential diagnosis of hypercalcemia: A case of hypercalcemia with normal PTH level
Francesca Pellicciotti, Andrea Giusti, Maria Carolina Gelli, Salvatore Foderaro, Alberto Ferrari, Giulio Pioli
Francesca Pellicciotti, Salvatore Foderaro, Alberto Ferrari, Giulio Pioli, Geriatric Unit, Arcispedale Santa Maria Nuova, Viale Risorgimento 80, 42123 Reggio Emilia, Italy
Andrea Giusti, Bone Clinic, Department of Gerontology and Musculoskeletal Sciences, Galliera Hospital, Corso Mentana 10, 16128 Genoa, Italy
Maria Carolina Gelli, Department of Pathology, Arcispedale Santa Maria Nuova, Viale Risorgimento 80, 42123 Reggio Emilia, Italy
Author contributions: All authors contributed to conception and design, acquisition and interpretation of data; Pellicciotti F, Giusti A and Pioli G contributed equally to the drafting of the article; Gelli MC, Foderaro S, Ferrari A and Pioli G revised the article critically for important intellectual content; all authors approved the final version to be published.
Correspondence to: Giulio Pioli, MD, Geriatric Unit, Arcispedale Santa Maria Nuova, Viale Risorgimento 80, 42123 Reggio Emilia, Italy. giulio.pioli@asmn.re.it
Telephone: +39-052-2296188 Fax: +39-052-2296122
Received: August 10, 2011 Revised: October 21, 2011 Accepted: January 7, 2012 Published online: January 10, 2012
Abstract
The hypercalcemias are a common and heterogeneous group of disorders, ranging from the occasional detection of a high level of serum calcium to a life-treating condition. In a patient presenting with hypercalcemia, a differential diagnosis can be established easily by measuring serum calcium and parathyroid hormone (PTH) concentrations. We describe the case of an 83-year-old man presenting with a severe symptomatic hypercalcemia with high-normal PTH level due to the coexistence of primary hyperparathyroidism and malignancy-associated hypercalcemia. The presence of two conditions producing hypercalcemia was revealed only during in-hospital stay and after the administration of an intravenous bisphosphonate, when the PTH concentration increased rapidly after bisphosphonate treatment with a decrease in serum calcium. The occurrence of two conditions producing hypercalcemia is a rare event in the literature, and should be considered in the presence of an abnormally high serum calcium level associated with normal or high-normal PTH, in order to establish a correct diagnosis and appropriate interventions.
