hypercalcemia with low associated PTH- possible Granulomatous Disease?

[caravan25]

I am 31, male, no known disease. 3 months ago, I had blood tests as part of a physical. I was found to have mildly elevated WBC + high serum calcium (11.4). All other results normal, incl. urinalysis + TSH. Intact parathyroid obtained w/ low-normal results (just above cut-off: 13 pg/ml in range of 12-65). Blood tested twice since then: decreasing Ca. (11.1 and 10.7, in range of 8.5-10.6). This may be a result of better hydration.(?) WBC now normal. 5 weeks ago, I noticed blood in sputum when coughing. (isolated incident). Underwent CT of chest/abdomen. No abnormalities. I had only slight cough + wheezing at time, now resolved. My Dr. diagnosed chron. sinusitis w/allergies as cause of blood. (Since then I have seen blood at least 1/2 of the time I blow my nose). As of 2nd set of results, my Dr. concluded that hypercalcemia is not a serious issue. I Have appt. w/ endo. next week for 2nd opinion. Most of the symptoms I am now experiencing might go unnoticed if I weren't hypersensitive due to the possibility of malignancy in my situation. Mostly I feel good. That said, I have recently developed fasciculations in my lower legs, arms, lips and eyes.  (Exacerbated by anxiety). Joints- especially knees- are intermittently  achy. Moderate headaches. Red eyes and floaters. Incidents of tinnitus. I have had some ear "clogging" and rare pain. In fact,  in the summer I experienced  strange "contraction" and clogging feelings deep within ears, w/rare pain. This gradually resoled. Possible Wegener's or other granulomatous? Occult malignancy? Next step? Thank you.

[National Jewish]

A mild elevation of your white blood cells (WBCs) and serum calcium may or may not be a sign of a health problem.  Since the values have spontaneously returned to the normal range a health problem is unlikely.

Blood in one's nasal secretions can come from the nose, sinuses or throat.  It almost never comes from anywhere lower in the respiratory tract.  Usually the blood is from an infection, but it could be a sign of a more serious disease, such as Wegener's granulomatosis.  However, a normal sinus CT scan along with a negative ANCA blood test would make this diagnosis unlikely.

You are understandably anxious.  Anxiety may explain some of your symptoms, including the fasciculations.  You should see an ENT to evaluate the tinnitus and ear "clogging".  Have your blood tests repeated after a while.

The likelihood of malignancy at age 31, as a cause of your signs and symptoms, is very low.  You should discuss your fear of granulomatous disease is relatively rare.  So talk with your doctor about your fear and do the necessary testing to rule it out.  These are relatively rare diseases.