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Severe symptomatic hypercalcaemia
  1. José María Calvo-Romero,
  2. María del Carmen Bonilla-Gracia
  1. Internal Medicine Service, Infanta Cristina University Hospital, Badajoz, Spain
  1. José María Calvo-Romero, Héroes de Cascorro 9, 31A, 06004 Badajoz, Spain

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A 49 year old man had a six week history of depression, constipation, proximal muscle weakness, anorexia, and weight loss of about 20 kg. The patient was not taking any medication and there was no history of nephrolithiasis, peptic ulcer, headache, or visual defects. Physical examination showed light proximal muscle weakness without atrophy, dehydration, and no other remarkable findings. The blood pressure was 140/85 mm Hg. The patient's blood chemical values were: glucose 5.2 mmol/l, urea nitrogen 13.2 mmol/l, creatinine 141 μmol/l, sodium 136 mmol/l, potassium 4.1 mmol/l, chloride 101 mmol/l, phosphorus 1.3 mmol/l, magnesium 0.98 mmol/l, alkaline phosphatase 115 U/l, creatine kinase 82 U/l, protein 76 g/l, and albumin 43 g/l. The blood calcium was 4.8 mmol/l, confirmed by repeated determinations. The 24 hour urinary calcium excretion was 12.3 mmol. An electrocardiogram revealed sinus rhythm and shortened QT interval. Free thyroxine and thyrotrophin serum concentrations were normal. Serum intact parathyroid hormone was 488 μg/l (normal values 10–65 μg/l).

Questions

(1)
What is your differential diagnosis for this case?
(2)
What further investigations would you perform?
(3)
What is the therapy for the severe hypercalcaemia in this case?

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