An 83-year-old patient with a personal history of hypertension and a mixed endometrial carcinoma, endometrioid and clear cell, stage T1N0M0, which was detected one year before the current admission due to metrorrhagia. The patient underwent hysterectomy with bilateral adnexectomy and pelvic lymphadenectomy, completing treatment with adjuvant brachytherapy, which was completed 5 months before the current admission. She attended gynaecological oncology outpatient clinics and has been free of disease to date.
On admission, she presented with progressive asthenia, anorexia and weakness of two weeks' duration, disorientation and bradyphasia of two days' duration, as well as constipation, polyuria, nocturia and polydipsia. A control blood test at her primary care centre showed a calcaemia of 15.35 mg/dL (reference values [v.r.] between 8.8 mg/dL and 10.2 mg/dL).
A blood test was performed in the ED showing a calcaemia of 16.1 mg/dL with an ionic calcium of 6.3 mg/dL (r.v. between 4.2 mg/dL and 5.4 mg/dL), with a normal physical examination, abdominal X-ray and electrocardiogram.
She was diagnosed with hypercalcaemic syndrome and treated with rehydration, intravenous zoledronate and furosemide, with calcaemia decreasing to normal values between the third and sixth day of treatment3,4.
The patient was admitted to the internal medicine ward where she was found to have: ESR 106 mm/h, albumin 3.16 g/dL, PTH 21.5 pg/mL (r.v. between 7 pg/mL and 82pg/mL), 25-hydroxyvitamin D3 9.9 ng/mL (r.v. between 6.6 ng/mL and 46.4 ng/mL) with negative tumour markers.
Given the patient's personal history of uterine neoplasia, a bone scan was requested, which was normal, and a thoracic and abdominal CT scan showed a 10 cm x 8 cm Douglas pouch mass with peritoneal tumour implants and pulmonary metastases. A transvaginal biopsy of the Douglas cul-de-sac mass was performed and confirmed a recurrence of her neoplastic disease. The patient is currently in a palliative care centre.