Hypercalcemia-what is the etiology

Case 1

Further investigations

CT scan chest : normal, no lymphadenopathy or lung infiltrates

Endocrinologist obtains more tests as below-

Serum and urine electrophoresis: normal

Angiotensin converting enzyme levels: negative

Urine Histoplasma antigen: negative

TB quantiferon: negative

Serum Fungal antibody panel (aspergillus, blasto, cocci, histoplasm): negative

Urine analysis: normal

Question 2

What is the reason for high calcitriol levels in granulomatous disease?

1. There is decreased release of FGF 23 from bone

2. There is decreased expression of 24-hydroxylase in kidney

3. There is increased expression of 1-hydroxylase in macrophages

4. There is increased expression of 1-hydroxylase in kidney