Which of the following might indicate a need for genetic testing in a patient with elevated calcium?

The indication for genetic testing in a patient with elevated calcium levels is particularly relevant in the context of Multiple Endocrine Neoplasia (MEN) syndromes, specifically type 1, as it is associated with inherited genetic mutations. MEN type 1, also known as Wermer’s syndrome, is characterized by a triad of pituitary adenomas, hyperparathyroidism, and pancreatic endocrine tumors. In patients presenting with elevated calcium levels, particularly if there is a familial history or atypical presentation for primary hyperparathyroidism, genetic testing can identify mutations in the MEN1 gene. This can help confirm a diagnosis of MEN1 and guide management, including the surveillance of other endocrine tumors associated with the syndrome.

While conditions like primary hyperparathyroidism are common causes of elevated calcium and may not require genetic testing unless there are red flags or a family history suggesting a hereditary syndrome, the presence of multiple endocrine neoplasia suggests a higher likelihood of a genetic basis for the condition. Therefore, in the scenario presented, suspecting multiple endocrine neoplasia type 1 directs toward genetic testing due to its hereditary nature and implications for disease management.