Multiple endocrine neoplasia Quiz: Ace Your Exams
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A 34-year-old woman comes to the office complaining of consistent diarrhea for the last 2 months. The patient has experienced watery, tea-colored diarrhea that happens even when she has not eaten anything. She denies any associated abdominal pain or difficulty swallowing. The patient feels fatigued and weak with muscle cramps which she attributes to being dehydrated. Medical history includes hyperparathyroidism and nephrolithiasis. The patient’s temperature is 37.0°C (98.6°F), pulse is 100/min, respirations are 20/min, and blood pressure is 100/60 mmHg. Physical examination shows dry mucous membranes and decreased skin turgor without abdominal tenderness. Laboratory tests show the following:
Which of the following is the most likely mechanism of this patient’s symptoms?
| Laboratory value | Result |
| Sodium | 144 mEq/L (reference range: 136-146 mEq/L) |
| Potassium | 2.5 mEq/L (reference range: 3.5-5 mEq/L) |
| Chloride | 93 mEq/L (reference range: 95-105 mEq/L) |
| Bicarbonate | 21 mEq/L (reference range: 22-28 mEq/L) |
| Calcium | 12 mg/dL (reference range: 8.4-10.2 mg/dL) |
| Glucose | 250 mg/dL (reference range: 70-110 mg/dL) |
| Parathyroid hormone | 350 pg/mL (reference range: 10-65 pg/mL) |
Which of the following is the most likely mechanism of this patient’s symptoms?
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