Differential Diagnosis for Elevated Calcium Level in an Elderly Woman
Single Most Likely Diagnosis
- Primary Hyperparathyroidism: This condition is the most common cause of hypercalcemia in adults, especially in postmenopausal women. It is characterized by an overproduction of parathyroid hormone (PTH), leading to increased calcium levels.
Other Likely Diagnoses
- Vitamin D Intoxication: Excessive intake of vitamin D can lead to hypercalcemia due to increased absorption of calcium from the gut.
- Malignancy: Various types of cancer, such as breast, lung, and multiple myeloma, can cause hypercalcemia through the production of parathyroid hormone-related protein (PTHrP) or other mechanisms.
- Hyperthyroidism: Although less common, hyperthyroidism can cause hypercalcemia due to increased bone turnover.
Do Not Miss Diagnoses
- Multiple Myeloma: A type of blood cancer that can cause hypercalcemia through the production of osteoclast-activating factors, leading to bone destruction.
- Hypercalcemia of Malignancy: As mentioned earlier, various cancers can cause hypercalcemia, and it is crucial to identify and treat the underlying malignancy.
- Familial Hypocalciuric Hypercalcemia (FHH): A rare genetic disorder that can mimic primary hyperparathyroidism but has a different treatment approach.
Rare Diagnoses
- Sarcoidosis: A systemic granulomatous disease that can cause hypercalcemia due to increased production of 1,25-dihydroxyvitamin D by activated macrophages.
- Lithium-Induced Hypercalcemia: Long-term use of lithium can lead to hyperparathyroidism and subsequent hypercalcemia.
- Familial Isolated Hyperparathyroidism: A rare genetic disorder characterized by hyperparathyroidism without other features of multiple endocrine neoplasia (MEN) syndromes.
- Thiazide-Induced Hypercalcemia: Certain diuretics, such as thiazides, can cause hypercalcemia by increasing renal calcium reabsorption.