In Search of . . .

A CLINICAL PROBLEM-SOLVING by Kyle Brizendine from University of Alabama School of Medicine, Birmingham.
A 61-year-old man was admitted with a week-long history of nausea, vomiting, nocturia, and polyuria. During the previous 6 months, he had noted progressive fatigue and a weight loss of about 7 kg (15 lb).
On physical examination the patient had orthostatic hypotension. The cardiovascular examination revealed a nonradiating, early systolic murmur.
The serum creatinine level was 3.9 mg per deciliter. The serum calcium level was 17.1 mg per deciliter (normal range, 8.8 to 10.4 mg per deciliter. Serum calcium and creatinine levels had been normal 8 weeks earlier. The serum parathyroid hormone (PTH) concentration was 9.05 pg per milliliter (normal range, 15 to 65) and the PTHrP concentration was less than 2.5 pmol per liter (normal value, <4.7).
A chest radiograph showed calcified granulomas in the right lung and calcified right hilar lymph nodes on the right side.
From 1976 to 1982, Leonard Nimoy  hosted a weekly television show called “In Search of . . .” which attempted to determine the underlying causes of various phenomena. Like Nimoy, physicians frequently find themselves searching for the answer that underlies certain observations. In this clinical problem-solving exercise, two puzzles needed to be solved. The first involved determining why the patient had nausea, vomiting, and polyuria. The answer was simple: hypercalcemia. The second puzzle entailed elucidating the underlying reason for the hypercalcemia. [Original Article]

Notes

• pico /ˈpaɪ.ko/, /ˈpi.ko/