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

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Pseudohyperparathyroidism

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
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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

Hyperparathyroidism

Hyperparathyroidism

Very low PTH..
0

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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