Uncommon cause of hypercalcaemia in metastatic breast carcinoma

Description

A 61-year-old female diagnosed to have carcinoma of the left side with disseminated skeletal metastases (figure 1) 5 years back presented with worsening bone pains and fatigability for the past 6 months. She was earlier treated with palliative radiotherapy to the spine and had been on oral letrozole; this was followed by a palliative mastectomy. In addition, she received parenteral bisphosphonates for metastases. Clinical examination was unremarkable. Blood biochemistry showed elevated calcium 12.8 mg/dL (N: 8.3–10.4) with an alkaline phosphatase of 61 U/L (N: 40–125) and creatinine of 0.7 mg/dL (N: 0.6–1.2), 25 OH vitamin D of 26 ng/mL (N: 30–75 ng/mL) and elevated parathyroid hormone (PTH) of 202 pg/mL (N: 8–50). Thus, she had a PTH-dependent hypercalcaemia and vitamin D insufficiency. We performed a sestamibi scan (figure 2A) and ultrasound of the neck (figure 2B), which revealed a right superior parathyroid adenoma. The present case had clinical and pathological features...

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