Case 14-1993

Presentation of CaseA 74-year-old woman was admitted to the hospital because of hypercalcemia and an osteolytic bone lesion.The patient had been in good health until six years earlier, when hypercalcemia was discovered. The alkaline phosphatase was increased, and the parathyroid hormone was six times the upper limit of normal. The calcium rose as high as 13.6 mg per deciliter (3.4 mmol per liter), although the patient denied all symptoms. An ultrasonographic examination of the neck was said to show no definite evidence of a parathyroid adenoma.Thereafter the patient continued to feel well except for intermittent fatigue until . . .