Question

A 56 year old man returns to the office because his calcium was found to be elevated at a previous visit. Although the remainder of his labs, including complete blood count, liver panel, and chemistries were all within normal limits, the patient's calcium was 11.9 mg/dL (normal: 8.5-10.5 mg/dL). The patient feels well and has no complaints. Current medications include verapamil, cetirizine, and atorvastatin. EKG shows a right bundle branch block, stable from previous. Which of the following is the most appropriate initial step in the management of this patient?

A. Serum parathyroid hormone level
B. CT of chest/abdomen
C. Genetic testing for multiple endocrine neoplasia, type 1
D. Discontinue verapamil
E. Intravenous saline and furosemide

Answer 1

The most appropriate initial step in the management of this patient is to measure the serum parathyroid hormone (PTH) level. A CT scan or genetic testing is not indicated at this stage.

Step-by-step explanation:

The most appropriate initial step in the management of this patient is to measure the serum parathyroid hormone (PTH) level (A. Serum parathyroid hormone level). Elevated calcium levels can be caused by various conditions, including hyperparathyroidism. Measuring the PTH level can help determine if the elevated calcium is due to increased PTH secretion from the parathyroid gland.

A CT scan of the chest/abdomen (B. CT of chest/abdomen) may be considered if the initial workup suggests a possible tumor as the cause of hypercalcemia.