BOF: 33
A 51-year-old woman was found to have hypercalcaemia on a
routine blood sample a year ago. Further investigations show
Calcium 2.81 mmol/L Sodium 141
mmol/L
Phosphate 0.8 mmol/L Potassium 3.9 mmol/L
Albumin 42 g/L Urea 4.5 mmol/L
PTH 6.9 nmol/L Creatinine 78
umol/L
Urinary calcium 0.5 mmol in 24 hrs
She is not taking any medications and complains of no
symptoms beyond occasional hot flushes. She has no history of renal stones.
What would you do next?
a) Arrange parathyroidectomy
b) Arrange a Chase-Auerbach test
c) Screen for myeloma
d) Arrange a bone scan
e) See her in a years time
Answer: e)
She may have familial hypocalciuric hypercalcaemia, not
primary hyperparathyroidism. Although 60% of patients with primary
hyperparathyroidism also have low urinary calcium, she has none of the
indications for surgery (symptoms, high urine calcium, Ca>3 etc).
Chase-Auerbach tests is used to diagnose the cause of hypoparathyroidism. She
is unlikely to have myeloma or malignancy – the high calcium was a year ago
and she is still asymptomatic
