Case Study 24-1 (3 points)

A 40-year-old woman presents to her physician complaining of marked left flank pain that began the previous night. She reports that the pain is worse than that of giving birth. She also reports blood in her urine earlier on the day she came to see her doctor. She has felt more fatigued, and as if her concentration has not been as good as normal for the last year or so, and she feels more forgetful. She has no significant past medical history. She is taking no medications. Family history contributes no pertinent information. On physical examination, she appears to be in extreme pain. There is marked tenderness on very gentle percussion over the left costovertebral angle. Labs are drawn and are notable for calcium 11.2 mg/dl (normal, 8.5 to 10.2 mg/dl), albumin 3.8g/dl (normal, 3.5 to 4.8 g/dl), and intact PTH 162 pg/ml (normal, 11 to 54 pg/ml). Renal function is normal (BUN 25 mg/dl and creatinine 0.9 mg/dl). Urine analysis is notable for blood and >50 red blood cells per high power field. This prompts a 24-hour urine collection, which reveals calcium elevated at 483 mg per 24 hour (normal, 100 to 250 mg per 24 hour).

Questions

1.      Which laboratory results are abnormal?

2.      What is the persuasive diagnosis for this patient? The differential diagnosis?

3.      What treatment is indicated for the disease?