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14 yrs old with sever joint pains, high protein, low sodium, primary hyperparathyroidism. Causes of joint pain?

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My (14 yr old) daughter is adopted so we have no family history...She has complained for years about joint pain (a doctor ruled out some autoimmune diseases and juv. arthritis.) Her most recent labs show high protein (5.2) and lower sodium (138). (possibly addisons? Wilsons?) She is getting close to primary hyperparathyroidism too, according to her labwork. Her primary care dr. had her do bloodwork for ceruloplasmin. Do you have any other ideas of what might be the cause of her symptoms? She has joint pain almost daily. (feet, hands, knees, or legs) I am tired of hearing growning pains after 13 years ongoing. She is 97 pounds and about 5'1". (Not growing too rapidly, in my opinion.) Her Bun/Creatinine Ration is 26 (high), and her Lipid Panel T. Chol/HDL ratio is 2.4 (low) and her Lymphocytes % is 22.3 (low). I wish that I could have maybe chosen an oncologist, but maybe you have some knowlege of something here.
Posted Sat, 28 Apr 2012 in Child Health
Answered by Dr. Sujeet N Charugulla 14 hours later
Hello and thanks for your query.

I shall make an effort to provide you with good professional recommendations specific to your questions.

Let me summarize the given results:
Protein 5.2 (marginal increase over upper limit of 5 gm/dl)
Sodium 138 (absolutely normal within 135-145) - Not low
Blood Urea Nitrogen/Creatinine ratio 26 - elevated and indicates a pre-renal cause of injury which is creating higher urea levels due to metabolism.
CH/HDL ratio 2.4 - indicates an ideal level of below 3.5 which is fine, not low.
Lymphocytes 22.3 % - well in between 16 - 33 % and not low.

So, grossly her BUN levels are elevated apart from the marginal rise in protein. Considering her long standing history of pains, with a normal BMI, do not see any serious issue in here like any obvious cancer. Hyperparathyroidism is a possibility, that your doctor might have reasoned based on her examinations. It is a benign condition and would be amenable to the right treatment even if it so. Its just that the metabolisms of Calcium, Vitamin D and parathyroid gland are so interwoven, it would be a while to confirm the right diagnosis. Either way - all have been shown to respond to treatment early.

Ceruloplasmin levels are done to rule out Wilson's disease caused by an excess of copper ions. Other possibilities I can speculate in name are - subclinical hypocalcemia, deranged vitamin D metabolism etc. But, there are many other benign conditions which have to ruled out by tests only apart from examinations, and speculation will not help. Approach is already being dealt by your doctor.

I am sure, she will do well in a short time after treatment starts.

Yet again, I duly appreciate your query to me, I do hope that you have found something useful to help you and I shall be glad to answer any further apprehensions.

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