MCQ Scenario: Hypercalcemia

An asymptomatic 72-year-old woman is evaluated after results of screening laboratory studies show hypercalcemia. Her only medication is calcium carbonate.

On physical examination, vital signs are normal and BMI is 24. There are no masses palpable in the neck.

Laboratory studies:
Albumin

4.2 g/dL (42 g/L)
Calcium, total

10.9 mg/dL (2.73 mmol/L)
Creatinine

1.0 mg/dL (88.4 µmol/L)
Parathyroid hormone

178 pg/mL (178 ng/L)
Urine calcium

120 mg/24 h (3 mmol/24 h)

A technetium Tc 99m sestamibi scan and ultrasound of the neck both show a 1.5-cm enlarged mass in the right tracheoesophageal groove. Results of dual-energy x-ray absorptiometry show T scores of –2.2 in the femoral neck and –1.5 in the lumbar spine.

Which of the following is the most appropriate next step in management?
A Biopsy of the neck mass
B Measurement of the 1,25-dihydroxy vitamin D level
C Measurement of the 25-hydroxy vitamin D level
D Parathyroidectomy

 

BIOPSY OF NECK MASS

 

option B

 

biopsy of mass. ?adenoma.

 

As T scores seems to evaluate osteopenia....may be due to increased release of parath hormone.

Biopsy can be done
Wat do u guys think!!!

 

biopsy of the mass