SudaMediCa, The Sudanese Medical Community

A45-year-old male presents to the hospital for acute abdominal pain and is found to have acute pancreatitis. He has no past medical his- tory but recently has noticed urinary frequency and muscle weakness. He takes no medica- tions. He denies alcohol use. His liver function tests during the episode are normal and mag- netic resonance cholangiopancreatography study (MRCP) demonstrates an absence of stones in the biliary tree as well as a normal pancreatic duct. His serum calcium is found to be markedly elevated during this episode. The patient recovers clinically, and repeat serum calcium is also found to be elevated 1 month after hospital discharge.

metastatic bone disease

nope

it is hyperparath
no symp suggest malignancy so mets excluded plus his age also
sarcoidosis arare disease and not causing hyper calcaemia commonlly itis only5 to 10 percent only and when it occured itis not maaarked hyper calcaemia
he is not taking medicne so vit d excluded
it is not lab error because one month later

The answer is (D)
The patient likely has hyperparathy- roidism. Hyperparathyroidism can lead to chronic hypercalcemia, a known cause of acute pancreatitis. Aserum calcium level canbe elevated in many patients during acute pancreatitis due to dehydration and should be checked after the event has resolved. Hyperparathyroidism would also explain his urinary frequency and muscle weakness. Laboratory error is unlikely given that the level is elevated on two occasions. Metastatic bone disease and sarcoidosis can also cause hypercalcemia but hyperparathyroidism is more commonly associated with pancreatitis. Vitamin D overdose is unlikely given his lack of medication use