LAUSR

Since the blood calcium was significantly increased, the following tests were carried out in the Department of Endocrinology. Ultrasound examination of parathyroid and thyroid was normal. Ultrasound examination of the urinary system was performed due to abnormal kidney function and hyperuricemia; the result was normal. 25-hydroxyvitamin D was 31.4 ng/ml (normal range 20–80 ng/ml); 24-h urinary calcium was 0.15 mmol/kg (normal range < 0.1 mmol/kg). Thyroid-stimulating hormones, triiodothyronine and tetraiodothyronine, were normal. Parathyroid hormone (PTH) was reduced, at 1.66 pg/ml (normal range 15–65 pg/ml). He had hypercalcemia, but as PTH was decreased, was it a malignant disease? Peripheral blood smear was normal; no blast or atypical cell was observed. Tumor markers (alpha fetoprotein, cancer antigen 199, cancer antigen 50, cancer antigen 724, cancer antigen 242, carcinoembryonic antigen) were negative. Computed tomography (CT) was performed to exclude solid tumors, chest CT showed slightly enlarged axillary lymph nodes on both sides, and abdominal CT showed enlarged lymph nodes in mesenteric area. X-ray examination of the bones was performed to exclude tumor metastasis or primary tumor of bones, but there was no bone destruction or osteoporosis in the humerus, ulna, radius, femur, tibia, fibula, and pelvis. The main symptoms of the patient were fatigue, lethargy, and vomiting. Was there an intracranial tumor? Magnetic resonance imaging of the head was done, but no abnormality was found.