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What Does My Lab Report Indicate?

Posted on Wed, 24 Dec 2014

Question: Hello. I went to my PMD a few weeks ago for a number of problems (see below). Labs revealed: high calcium, low vit D, low phosphate and low Vit B12. I also had a hip x-ray due to hip pain. The x-ray revealed a 2 mm circumscribed sclerotic lesion in the femoral head junction likely reflecting a bone island. My PMD suggested taking Vit D for the deficiency (2000 iu/day) and for the high calcium. She had me do a sonogram of my thyroid which was unremarkable, except for a simple cyst. I think that she said she also checked my parathyroid hormone levels but I am unsure. As for the lesion issue she suggested that I see an Orthopedist. Ortho ordered an MRI which is pending. Depending on the MRI results I will likely also need a bone scan. However, in addition I have been having worsening pain in the hip which has now also started in the other hip, as well as rib and back pain. I also have had some small twitching of my hands. I feel worse on the vit D. The pain is so bad that I went to the ER twice and they suggested to continue w/ outpt w/u. Should I still be taking the vit D? I thought that Vit D promotes Ca to be absorbed so wouldn’t taking Vit D be contraindicted? Please help, I don’t know what to do.

Answered by Dr. Noble Zachariah (1 hour later)

Brief Answer:
Primary Hyperparathyroidism more likely.

Detailed Answer:
Hello,

Welcome to HCM and thank you for the query.
The commonest cause for high calcium level is Primary Hyperparathyroidism.
This is often associated with low vitamin D level.
Malignancy is another cause. Parathormone (PTH) is elevated in Primary hyperparathyroidism and would be low in malignancy .Bone pain can occur in both. Excess PTH also can result in subperiosteal resorption, leading to osteitis fibrosa cystica with bone cysts.
I agree with you that vitamin D increases Calcium absorption from the gut. However when used in people with Primary hyperthyroidism and vit D deficiency, it does not raise the serum calcium significantly.
Vitamin D deficiency is found in several diseases and there is a belief that it may be only a marker of certain diseases.
So your clinical picture fits in more with Primary hyperparathyroidism than with a malignancy causing hypercalcemia.
So relax, complete your investigations. Please let me know the PTH value. It will be helpful in the diagnosis.
Dr Noble Zachariah

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Noble Zachariah (21 minutes later)

Hi Dr. XXXXXXX

Thank you for your reply. I have additional questions. I have also read that even if the parathyroid level is normal, it does not exclude hyperparathyroidism. A PTH that is inappropriately elevated in relationship to the serum calcium may also indicate the disorder. Should I see an endocrinologist?

Answered by Dr. Noble Zachariah (27 minutes later)

Brief Answer:
Yes

Detailed Answer:
You are welcome.
You are right. In a study of 271 consecutive patients with primary hyperparathyroidism (HPT) undergoing surgery for primary HPT, 20 patients had serum iPTH levels within the normal range (10–65 ng/l).
It would be a good idea to see an endocrinologist.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Noble Zachariah (18 minutes later)

Thanks again. You were really helpful. I will keep you informed.

Answered by Dr. Noble Zachariah (5 hours later)

Brief Answer:
You are welcome

Detailed Answer:
Thanks. Have a great day

Note: For further queries, consult a joint and bone specialist, an Orthopaedic surgeon. Book a Call now.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar