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World J Clin Oncol. 2012 Jan 10;3(1):7-11. doi: 10.5306/wjco.v3.i1.7.

Challenges in the differential diagnosis of hypercalcemia: A case of hypercalcemia with normal PTH level.

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Francesca Pellicciotti, Salvatore Foderaro, Alberto Ferrari, Giulio Pioli, Geriatric Unit, Arcispedale Santa Maria Nuova, Viale Risorgimento 80, 42123 Reggio Emilia, Italy.


The hypercalcemias are a common and heterogeneous group of disorders, ranging from the occasional detection of a high level of serum calcium to a life-treating condition. In a patient presenting with hypercalcemia, a differential diagnosis can be established easily by measuring serum calcium and parathyroid hormone (PTH) concentrations. We describe the case of an 83-year-old man presenting with a severe symptomatic hypercalcemia with high-normal PTH level due to the coexistence of primary hyperparathyroidism and malignancy-associated hypercalcemia. The presence of two conditions producing hypercalcemia was revealed only during in-hospital stay and after the administration of an intravenous bisphosphonate, when the PTH concentration increased rapidly after bisphosphonate treatment with a decrease in serum calcium. The occurrence of two conditions producing hypercalcemia is a rare event in the literature, and should be considered in the presence of an abnormally high serum calcium level associated with normal or high-normal PTH, in order to establish a correct diagnosis and appropriate interventions.


Bisphosphonates; Hypercalcemia; Malignancy-associated hypercalcemia; Parathyroid hormone; Primary hyperparathyroidism

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