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  #1  
Old 01-20-2012
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Question Guess the cause of this hypercalcemia!

A 45-year-old woman had frequent headaches for about 1 month. She suddenly experienced a generalized seizure and
became obtunded. She is taken to the emergency department, where a physical examination indicates no abnormalities.
Laboratory findings include serum calcium of 15.4 mg/dL, serum phosphorus of 1.9 mg/dL, and albumin of 4.2 g/dL. A
chest radiograph shows multiple lung masses, and there are lytic lesions of the vertebral column. Which of the following
conditions best accounts for these findings?
(A) Parathyroid carcinoma
(B) Renal failure
(C) Metastatic breast cancer
(D) Vitamin D toxicity
(E) Tuberculosis
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Old 01-20-2012
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Ans A .........increased Calcium , lytic lesions ....
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Old 01-20-2012
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i think A too
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Old 01-20-2012
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Correct Answer correct answer is C

this was alittle tricky one as the case showed manfestation of hypercalcemia and lytic bone lesion u thought directly of parathyroid carcinoma while infact he mentioned in case a lung mass which make us must think of hypercalcemia from malignancy which is common specially from lung cancer which in this case according to the available choices may be caused by breat metastases ,, wish i made it clear
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Old 01-20-2012
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Quote:
Originally Posted by menatallah Elgohary View Post
this was alittle tricky one as the case showed manfestation of hypercalcemia and lytic bone lesion u thought directly of parathyroid carcinoma while infact he mentioned in case a lung mass which make us must think of hypercalcemia from malignancy which is common specially from lung cancer which in this case according to the available choices may be caused by breat metastases ,, wish i made it clear
can u pls explain how malignancy will cause hypercalcemia.couldnt understand

thanks alot
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Old 01-20-2012
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yes , the answer didnt make sense to me , as only squamous cell ca make Pthrp to cause hypercalemia , metastasis dont ..... mostly it should be parathyroid ca or there should be a reason to rule it ........
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Old 01-21-2012
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Correct Answer Yes... Is C

Quote:
Originally Posted by step_enhancer View Post
can u pls explain how malignancy will cause hypercalcemia.couldnt understand

thanks alot
Hypercalcemia of malignancy is the most common metabolic complication of breast cancer. The bone destruction occurring in the osseous metastatic lesions can result in elevated serum calcium levels and the associated symptoms of hypercalcemia: fatigue, nausea, vomiting, dehydration, and mental status changes. Hypercalcemia of malignancy is also associated with an increase in renal tubular resorption and a decrease urinary calcium excretion that further increases the serum calcium level. The mechanism of hypercalcemia of malignancy involves production of tumoral parathyroid hormone-related protein (PTHrP) as well as bone-resorbing cytokines, vitamin D metabolites, and prostaglandins

http://www.medscape.com/viewarticle/447549_8
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Old 01-21-2012
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□ (C) Metastatic breast cancer
because the lytic lesion and hyper ca
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Old 01-21-2012
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dr mexito has explained it greatly ,, don't have anything to say after his explanation
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Old 01-21-2012
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why can't it be A?
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Quote:
Originally Posted by khushi.chahal View Post
why can't it be A?
cause in the case he mentioned lung mass to give me an indication of a presence of carcinoma and increase in PTH is not due to a carcinoma in the thyroid itself but it can be this squameous carcinoma of the lung that is known to secret a PTH like molecules that causes an increase in calcium level through bone osteoclasting and according to the choices he gave a metastatic breast cancer which can cause this lung cance causing sever hypercalcemia of a malignant origin which is the second most common cause after parathyroid hyperplasia or carcinoma ,, wish that clear it
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Old 01-21-2012
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Quote:
Originally Posted by menatallah Elgohary View Post
cause in the case he mentioned lung mass to give me an indication of a presence of carcinoma and increase in PTH is not due to a carcinoma in the thyroid itself but it can be this squameous carcinoma of the lung that is known to secret a PTH like molecules that causes an increase in calcium level through bone osteoclasting and according to the choices he gave a metastatic breast cancer which can cause this lung cance causing sever hypercalcemia of a malignant origin which is the second most common cause after parathyroid hyperplasia or carcinoma ,, wish that clear it
When i read this question i thought of squamous cell carcinoma of the lung, isn't that what A is?
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Quote:
Originally Posted by khushi.chahal View Post
When i read this question i thought of squamous cell carcinoma of the lung, isn't that what A is?
A in choices is parathyroid carcinoma !!!! not squamous cancer
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Quote:
Originally Posted by menatallah Elgohary View Post
A in choices is parathyroid carcinoma !!!! not squamous cancer
Aaah parathyroid GLAND carcinoma lmao "-_-
Ok got it now

Thanks!
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Old 01-21-2012
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you gays amazing , if i found this any were i'll answered (A) as parathyroid and i'll miss it
thanx for explanation this ...
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