13year old female presented with 3 weeks h/o pain right knee and right elbow, vomitting and constipation..She had h/o menorrhagia for which gynaec doctor gave ocps 1 month back. o/e pallor + ln - chest no added sounds,no murmurs abdomen soft cns-wnl x-ray were taken which is posted below s.calcium-12.6 s.phosphate-2.4 iPTH<1 rft-30/0.6 serum electrolytes-sodium 137 potassium-4.6 cbc-8500 ure-pus cells 6-8 serum ace- normal serum ferritin-350 ldh-368 ALP-128
Its a case of hyperparathyroidism.
Pseudohyperparathyroidism
Hyperparathyroidism
Praaneolastic syndrome causing pseudohypoparathyrodism
Sir multiple myeloma is usual in old age people.. can we expect this 13yr old male @ sabesan ramachandran??
Hyperparathyroidism?? Please get sr.pth, may need excision of parathyroid if required..
Pseudohyperparathyroidism xray shows punched out lesions
Thank you everyone for the input.. Final diagnosis came today after BMT and flow cytometry.. It's a case of B cell Acute Lymphoblastic Leukaemia
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