CC: Chronic Constipation x 5 years
PMHx
HTN
Managed with Metoprolol
Tobacco use
Screen for depression
FHx
Both parents with HTN
Labs
TSH
Normal
Renal function
Normal
Calcium: elevated
Recheck
11.2 mg/dL (elevated)
Demographics
48 y/o
Female
Management
Estrogen
Calcitonin
Laxatives prn
+/- Biphosphonates
Imaging
Colonoscopy
Normal
EKG
Tall and peaked T waves
Short QT interval
Absent p waves
X-ray
Normal
DEXA scan
Low bone density
Neck US
Possible parathyroid adenoma
Serum PTH
Low to normal, consider...
Metastatic tumors (hypercalcemia of malignancy)
Multiple Endocrine Neoplasia (MEN)
Granulomatous disease: sarcoidosis, TB
Elevated
Primary hyperparathyroidism
Secondary hyperparathyroidism