A 61-year-old man comes to the office for follow-up of long-standing type 2 diabetes mellitus. Treatment currently consists of metformin, dietary modification, and regular exercise. On his current regimen, the patient's weight has been mostly stable over the last 2 years, but he has noticed some weight loss in the last 6 weeks. He also has mild constipation but no abdominal pain, nausea, or excessive urination. Medical history is significant for hyperlipidemia and hypertension, for which he takes atorvastatin, amlodipine, and valsartan. He also takes low-dose aspirin and a daily multivitamin. The patient does not drink alcohol but has a 45-pack-year smoking history. His father had type 2 diabetes mellitus and died of a stroke, and his mother had thyroid cancer that required surgery. Blood pressure is 134/80 mm Hg and pulse is 88/min. BMI is 30 kg/m2. Neck examination is normal. Lungs are clear to auscultation. Abdominal examination reveals no masses or tenderness. Laboratory results are as follows:
Six months ago, his chemistry profile was normal.
The patient is scheduled for additional testing but is unable to return for evaluation. About 2 weeks after his visit, he is brought to the emergency department due to weakness, nausea, increased urination, and progressive constipation. Blood pressure is 90/70 mm Hg and pulse is 110/min. Mucous membranes are dry. Laboratory results show a serum parathyroid hormone level of 9 pg/mL, serum calcium of 14.1 mg/dL, and serum creatinine of 2.6 mg/dL. Which of the following is the most likely cause of this patient's hypercalcemia?
Definitions:
Erikson's Developmental Theory
A theory by Erik Erikson that outlines eight stages of psychosocial development from infancy to adulthood.
Psychosocial
Refers to the interrelation of social factors and individual thought and behavior.
Operant Learning Theory
A theory of learning that argues behavior is controlled by the consequences that follow it, emphasizing reinforcement and punishment.
Self-disclose
The act of revealing personal, intimate information about oneself to others, which plays a crucial role in forming close relationships.
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