A 55-year-old woman presented with a 3-week history of nausea and vomiting. Her only medical complaints were frequent dyspepsia, for which she was taking indigestion tablets, and asthma for which she was taking a salbutamol inhaler as required.
On examination, there was no evidence of lymphadenopathy, her chest was clear on auscultation and abdominal examination was normal.
Investigations (before and after taking omeprazole for 3 weeks):
beforeafternormal
erythrocyte sedimentation rate (mm/1st h)44<30
serum creatinine (µmol/L)17011060C110
serum corrected calcium (mmol/L)2.852.402.20C2.60
serum phosphate (mmol/L)1.90.8C1.4
serum angiotensin-converting enzyme (U/L)8525C82
plasma parathyroid hormone (pmol/L)0.44.40.9C5.4
What is the most likely cause of the hypercalcaemia?
A . milkCalkali syndrome
B . multiple myeloma
C . parathyroid hormone-related peptide-secreting malignancy
D . primary hyperparathyroidism
E . sarcoidosis
Answer: A
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