A 45-year-old woman comes to the emergency department with confusional symptoms accompanied by dysphonia. On examination she has a palpable neck mass and a blood test shows plasma calcium levels of 15 mg/dL (normal up to 10.2 mg/dL). Given these findings, which of the following diagnoses should be suspected?
Palpable mass in the neck: suspect thyroid/parathyroid pathology. It is associated with hypercalcemia, therefore, the option of medullary thyroid cancer is ruled out (it does not affect the level of calcemia). To think of MEN type I we should associate other pathologies (pituitary, pancreatic or duodenal tumors). The presence of a calcemia higher than 13mgr/dl, together with dysphonia, indicates a malignant tumor (higher calcemia level and infiltration), therefore we opt for option 1.
Parathyroid carcinoma.
Medullary thyroid carcinoma.
MEN type I.
Parathyroid adenoma.
The presence of a calcemia higher than 13mgr/dl, together with dysphonia, indicates a malignant tumor (higher calcemia level and infiltration), therefore we opt for option 1.
It is associated with hypercalcemia, therefore, the option of medullary thyroid cancer is ruled out (it does not affect the level of calcemia).
To think of MEN type I we should associate other pathologies (pituitary, pancreatic or duodenal tumors).