CC: Chronic Constipation x 5 years

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diuretic renal scintigraphy

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PTH

Elevated

Primary hyperparathyroidism

Low to normal, consider...

Granulomatous disease: sarcoidosis, TB

Multiple Endocrine Neoplasia (MEN)

Metastatic tumors

CC: Chronic Constipation x 5 years

Imaging: Colonoscopy

Management

Laxatives more than 1/week

High-fiber supplements

Stool softeners

Demographics

Female

48 y/o

Too young for DEXA scan

Labs

Calcium: elevated

Recheck

11.2 mg/dL (elevated)

Renal function

TSH

Normal

FHx

Both parents with HTN

PMHx

Tobacco use

HTN

Managed with Metoprolol