Hypercalcemia: An Ominous sign of Malignancy

Hypercalcemia is a disorder commonly encountered by primary care physicians. The diagnosis often is made incidentally in asymptomatic patients Clinical manifestations affect the neuromuscular, gastrointestinal, renal, skeletal, and cardiovascular systems. 90% of cases of hypercalcemia are due to primary hyperparathyroidism and malignancy. This article highlights the importance of proper work-up of elevated serum calcium levels and complications that can arise from failure to do so. This is a case report of a 63-year-old female who was found to have asymptomatic hypercalcemia of 10.5 mg/dl but was lost to follow up and presented four years later to her primary care physician with complaints of pain in the neck and weakness in bilateral shoulders, arms, wrists, and numbness of 4th and 5th digits. MRI revealed lytic lesions on the cervical and thoracic spine with compression deformity likely due to metastatic breast cancer. Lab reports revealed a serum calcium level of 12.1mg/dl and the patient’s chart (mammogram/ breast US) confirmed malignant breast cancer.