Severe hypercalcaemia in an infant

MARTÍN, MARÍA JULIA; MAURY FUENTES, KELLY; NOVOA DÍAZ, MARÍA BELÉN; CAO, GABRIEL; GIGOLA, GRACIELA; BRUNETTO, OSCAR; GENTILI, CLAUDIA

JOURNAL OF CLINICAL PATHOLOGY

B M J PUBLISHING GROUP

Año: 2021 vol. 74

0021-9746

CLINICAL PRESENTATIONA three-month-old male patient arrived at Children´s Hospital ?Dr. Pedro de Elizalde? (Buenos Aires, Argentina) with irritability, rejection of food and altered neurobehavioral development. An abnormal mass was found in the right flank upon palpation of the abdomen.LABORATORY INVESTIGATIONSLaboratory tests showed high concentrations of total serum calcium: 6.24 mmol/L (range of normal values in this age group: 2.20 - 2.82 mmol/L); low concentrations of PTH: 0.175 pmol/L (normal 1.06 ? 7.42 pmol/L) and phosphorus: 0.935 mmol/L (normal: 1.55 ? 2.39 mmoL). 25(OH) Vitamin D measurements showed normal values (63 nmol/L), considering the age group, where the vitamin D insufficiency is defined in the range of concentrations between 30?50 nmol/L. Other laboratory test values, including blood cell count, were within normal limits. He was hydrated and initially treated with pamidronate and calcitonin but hypercalcaemia did not revert.QUESTIONS FOR DISCUSSION1) What key aspects can be useful for the diagnosis of the abdominal mass detected in this patient?2) What are the possible causes of hypercalcaemia in an infant?3) What is the differential diagnosis of the mass identified in this patient with respect to hypercalcaemia?4) If it is a neoplasm, what are the probable mechanisms of hypercalcaemia?