Primary hyperparathyroidism and hypercalcemia
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Answer: B 
DISCUSSION:
Malignant tumors rarely secrete PTH itself; they can secrete PTHrP or cytokine activators of osteoclast activity. The diagnosis of primary hyperparathyroidism is supported by hypercalcemia with mild hyperchloremic metabolic acidosis and a chloride-phosphate ratio greater than 33 or a modified chloride (mmol. per liter/mg. per dl.) phosphate ratio greater than 500. Familial hypocalciuric hypercalcemia is distinguished from primary hyperparathyroidism by a low urine calcium. Serum calcium changes approximately 0.8 mg. per dl. for every 1 gm. per dl. change in serum albumin. Thiazide diuretics can cause hypercalcemia and should not be given to patients who are hypercalcemic.
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