Axillary Mass and Hypercalcemia: The Value of a Physical Examination

Abstract

Modern diagnostics are sophisticated but cannot replace physical examination. Here we describe a 75-year-old woman with abdominal discomfort, nausea, and emesis for 3 weeks in the setting of hypercalemia and a right axillary mass. This case highlights the value of physical examinations. HYPERCALCEMIA OF MALIGNANCYHypercalcemia and an axillary mass are concerning for malignancy, including breast and squamous cell lung carcinoma, portending a poor prognosis. 1,2 Malignant hypercalcemia is usually secondary to malignant production of parathyroid hormone-related peptide (PTH-rP), osteolytic metastases (breast, lung, and hematologic), or tumor production of 1,25hydroxy vitamin D (hematologic).Initial assessment includes thorough history and physical examination, followed by diagnositic evaluation including PTH, extended electrolytes, creatinine, and albumin. If malignancy is suspected, PTH-rP, 1,25-hydroxy vitamin D, protein electrophoresis, and alkaline phosphatase should be measured. Imaging is often appropriate. Nonmalignant causes include medications (eg, thiazides), fungal infection, sarcoidosis, and hypoadrenalism.