Differential Diagnosis for Hypercalcemia, Hyperkalemia, and Elevated Glucose
Single Most Likely Diagnosis
- Adrenal Insufficiency: This condition can lead to hyperkalemia due to the lack of aldosterone, which regulates potassium levels. Hypercalcemia can occur due to increased bone resorption and decreased renal excretion of calcium. Elevated glucose levels can be seen due to the stress response and cortisol deficiency.
Other Likely Diagnoses
- Hyperparathyroidism: Although primary hyperparathyroidism typically causes hypokalemia, some cases can present with hyperkalemia, especially if there's associated renal impairment. Hypercalcemia is a hallmark, and glucose levels can be elevated due to the effects of parathyroid hormone on glucose metabolism.
- Malignancy: Certain malignancies, such as multiple myeloma or lymphoma, can cause hypercalcemia through the production of parathyroid hormone-related protein (PTHrP) or other mechanisms. Hyperkalemia can occur due to tumor lysis syndrome or renal impairment, and elevated glucose levels can be seen due to the stress response or insulin resistance.
- Familial Hypocalciuric Hypercalcemia (FHH): This genetic disorder leads to hypercalcemia due to altered calcium sensing by the parathyroid glands. Hyperkalemia can occur, and glucose levels can be elevated due to the effects of hypercalcemia on glucose metabolism.
Do Not Miss Diagnoses
- Pheochromocytoma: Although less common, pheochromocytoma can cause hypercalcemia, hyperkalemia, and elevated glucose levels due to the excessive production of catecholamines, which can lead to renal impairment, bone resorption, and glucose release from energy stores.
- Thyroid Storm: This life-threatening condition can cause hypercalcemia, hyperkalemia, and elevated glucose levels due to the excessive production of thyroid hormones, which can lead to increased bone resorption, renal impairment, and glucose release from energy stores.
Rare Diagnoses
- Vitamin D Intoxication: Excessive intake of vitamin D can lead to hypercalcemia, which can cause hyperkalemia due to renal impairment. Elevated glucose levels can occur due to the effects of hypercalcemia on glucose metabolism.
- Sarcoidosis: This granulomatous disease can cause hypercalcemia due to increased production of 1,25-dihydroxyvitamin D. Hyperkalemia and elevated glucose levels can occur due to renal impairment and the stress response.