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




Sir multiple myeloma is usual in old age people.. can we expect this 13yr old male @ sabesan ramachandran??

What about the osteolytic lesions of the long bones and skull, could it be multiple myeloma..?

Pseudohyperparathyroidism xray shows punched out lesions

I agree with Dr K Chitta

Parathyroid may not be high in some tumor conditions.. also get renal profile

Yes.. might be PTHrP due to some occult malignancy.. Awaiting result

Very low intact PTH... Thinking on the line of malignancy/granulomatous disease..any other possibilities??. blood counts are normal.. peripheral smear also came normal.. planning to do BM examination



Very low PTH..

Hyperparathyroidism?? Please get sr.pth, may need excision of parathyroid if required..

Sir,intact PTH is very low...less than 1ng/l
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