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A 35-Year-Old Man Comes to the Office Due to Fatigue

question 389

Multiple Choice

A 35-year-old man comes to the office due to fatigue, palpitations, and weight loss. He has lost more than 4.5 kg (10 lb) in the last few months. He has been under a lot of stress at work, and his sleep is poor. The patient also has bilateral eye irritation, excessive tearing, and redness. He has no fever, shortness of breath, bone pain, or abdominal symptoms. He takes lisinopril for hypertension.
The patient tested negative for HIV 5 months ago after a new sexual encounter. He takes no over-the-counter medications. He smoked cigarettes for a year when he was in his early 20s. The patient drinks a glass of red wine every Friday. He works as a manager in a department store. His father died of prostate cancer at age 65, and his mother had a lumpectomy for breast cancer.
Temperature is 37.2 C (99 F) , blood pressure is 150/80 mm Hg, pulse is 104/min and regular, and respirations are 18/min. The patient has no enlarged lymph nodes, and his spleen is not palpable. There is swelling of soft tissues around his eyes but no proptosis. The remainder of the physical examination is unremarkable.
Laboratory results are as follows:

Repeat serum calcium is 10.8 mg/dL. Serum parathyroid hormone is 7 pg/mL, 1,25-dihydroxyvitamin D is 19 pg/mL (25-65 pg/mL) , and 25-hydroxyvitamin D is 30 ng/mL (15-80 ng/mL) .
Which of the following is most likely to provide the etiology for this patient's hypercalcemia?

Definitions:

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A document that is produced, stored, and transmitted in a digital format.

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Consideration

The value (such as money, service, or goods) promised to another when making a contract.

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