Necrotizing enterocolitis — USMLE Step 2 CK MCQ

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HardPediatricsNecrotizing enterocolitisUSMLE Step 2 CK

A patient with diffuse large B-cell lymphoma has confusion and calcium 13.6 mg/dL. PTH and PTH-related peptide are suppressed, 1,25-dihydroxyvitamin D is markedly elevated, and volume depletion has been corrected. Which targeted initial drug is most appropriate?

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Correct answer: E — Begin systemic glucocorticoids

Suppressed PTH and PTH-related peptide with elevated 1,25-dihydroxyvitamin D identifies calcitriol-mediated hypercalcemia, classically produced by lymphoma. Systemic glucocorticoids reduce extrarenal calcitriol production and are the targeted initial drug; an intravenous bisphosphonate or denosumab is added if severe or symptomatic hypercalcemia persists. Cinacalcet targets PTH-driven disease, calcitriol worsens calcium absorption, thiazides reduce urinary calcium excretion, and calcitonin loses effect rapidly and cannot serve as definitive monotherapy.

Reference: Endocrine Society clinical practice guideline: Hypercalcemia of malignancy. https://www.endocrine.org/clinical-practice-guidelines/hypercalcemia