At morning report we heard a case of a 70 year old female with chief complaint of generalized weakness and “dizziness.” Difficult to truly determine whether it was vertigo or orthostatic hypotension leading to lightheadedness. On basic labs her calcium was elevated to 15.5, low PTH and high vitamin D 1,25 hydroxyl. Her CT chest demonstrated mediastinal LAD and LN biopsy showed non-caseating granuloma prelim, final pending.
A review of work up of hypercalcemia, granulomatous diseases leading to hypercalcemia and mechanism and treatment can be found here.
Remember when trying to ascertain the underlying cause of dizziness it is important to determine if the sensation is related to standing, laying down, head movement, if there are associated visual findings or hearing difficulty. On exam looking for nystagmus, gait abnormalities and other neurological signs (nausea, vomiting, headache, numbness, etc) are very important to help determine if there is a central or peripheral cause.