A 72-Year-Old Woman With Back Pain and Hypercalcemia

Tarah Ballinger, MD; Kathy D. Miller, MD


July 27, 2016

Physical Examination and Workup

The physical examination reveals a healthy woman who appears younger than her stated age. She is well-appearing and in no distress. Vital signs include a temperature of 96.4°F (35.8°C), heart rate of 75 beats/min, blood pressure of 152/78 mm Hg, and oxygen saturation of 98% on room air. Her body weight is 158.7 lb, which is stable from 160.9 lb 3 months ago.

Figure 1.

Figure 2.

Her physical examination is otherwise unremarkable except for well-healed surgical scars on the left breast and left axilla. No masses or skin changes are noted in either breast. Her musculoskeletal examination is unremarkable, with no pain upon palpation of the spine or paraspinal muscles. Her strength is normal and symmetrical in the bilateral lower extremities, and sensation is intact.

Routine laboratory testing is significant for a calcium level of 14 mg/dL and a creatinine level of 1.4 mg/dL (baseline, 0.8 mg/dL). The patient's electrolyte levels are within the normal ranges, and her albumin level is 4 mg/dL. Her complete blood count is unremarkable, except for mild anemia with a hemoglobin level of 11.6 g/dL (which is her baseline).

She was given intravenous fluids, and MRI of the lumbar spine with contrast was performed to further evaluate her pain (Figure 1). This was followed by CT of the chest, abdomen, and pelvis owing to multiple bony lesions seen on MRI (Figure 2).


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