MED-18. Paget's disease in the differential diagnosis of hypercalcemia.

The differential diagnosis of hypercalcemia includes many disorders of bone and mineral metabolism including Paget's disease of bone. A case is reported with a review of the incidence in African American patients. The patient is a 69-year-old African American woman who was noted to have hypercalcemia on routine laboratory studies. Her past medical history was significant for hypertension, seizure disorder, osteoarthritis, carpal tunnel syndrome, cerebrovascular disease, allergic rhinitis, early Alzheimer's disease, post-menopausal status, schizoaffective disorder and a prior surgical repair of an ankle and lower extremity fracture. Medications included phenytoin, donepezil haloperidol, benztropine, aspirin, clopidogrel, bisoprolol with hydrochlorothiazide and fexofenadine as needed for allergy symptoms. Her physical examination included normal vital signs, thickened joints of the hands, ankles and knees and a well-healed surgical scar on the right lower extremity. Laboratory studies were within normal limits except for a mildly elevated calcium of 10.5 mg/dl with a serum albumin of 3.7, and alkaline phosphatase of 160 U/L. Intact PTH, serum protein electrophoresis, complete blood count and urinalysis were all normal. A chest radiograph was normal. A total body bone scan revealed increased radiotracer uptake in the left parietal and temporal bones. Initial therapy included adequate hydration and risedronate 30 mg daily for approximately 2 months. Additionally, counseling regarding fall reduction strategies was done with the patient and her daughter to minimize the risk of injury in this patient. Hypercalcemia improved the patient has remained stable at the present time. Bisphosphonates are effective for suppressing the biochemical activity of Paget's disease and the histological activity including bone resorption. Paget's disease increases in incidence with aging. In conclusion, prompt evaluation of hypercalcemia in elderly patients may include evaluation for Paget's disease. Newer treatments can prevent morbidity and disability associated with the destructive bony lesions of Paget's disease.

Myra A. Kleinpeter, MD, MPH. Tulane University Health Sciences Center, New Orleans, LA.