A 30-year-old woman is presented to ER with complaints of progressive lethargy, constipation, muscle weakness, and increased thirst and urination. On fuher asking, the patient admits taking large doses of vitamin and mineral supplements on a daily basis. The most likely metabolic abnormality causing patient’s symptoms are also seen in which of the following clinical conditions?
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Description: Clinical features are consistent with hypercalcemia caused by large doses of Vitamin D. Hypercalcemia result in impaired depolarization of neuromuscular membranes. This leads to Muscle weakness Constipation Impaired concentration of urine in distal tubule resulting in polyuria and increased thirst Normally, conversion of 25 hydroxy vitamin D to 1, 25 dihydroxy vitamin D regulated by PTH. In Sarcoidosis, there is an expression of 1-alpha hydroxylase enzyme which is responsible for PTH independent conversion, thereby causing hypercalcemia (10% cases) Granuloma produces | 1,25 dihyroxy Vit D | Vit D causes increased absorption of calcium from intestine | Hypercalcemia Option A image shows HRCT scan of chest: patchy reticular nodularity, with areas of confluence - likely sarcoidosis Chronic inflammatory lesions around nose, eyes, and cheeks suggestive of lupus pernio. Option B: Biliary obstruction. (dilated biliary system) Option C: Serum IHC reveals an IgGk monoclonal protein; and macroglossia of a pt. suggestive of amyloidosis
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