All are canses 0f hypercalcemia, except-
Correct Answer: Phenytoin toxicity
Description: although hyper parathyroidism ,a frequent cause of asymptomatic hypercalcemia, is a chronic disorder in which manifestations may be expressed only after months or years , hypercalcemia may manifest early in malignancy. In patients with sarcoidosis and other granulomatous disease , such as TB, excess 1,25(OH)2D is synthesized in macrophages or other cells .The usual regulation of active metabolite production by calcium phosphate or PTH does not operate in this patients.PTH level are low and 1,25(OH)2D level is elevated Vit A is a rare cause and is most commonly a side effect of dietary faddism .Ca level can be elevates into the 3-3.5 mmol/l range(Harrison 17 pg 2387)
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