PCP insists not PHPT

[Raylee505]

49 y/o w female, good health, exercise before this. Reg. periods
After several months of extreme fatigue, pain in R flank, hip and thigh and problems sleeping due to the pain I went to see my PCP in Jan/2011.

Ordered Chest x-ray, renal ultra sound and labs (CMP, Vit D, CBC w/Diff)

1/29/11

D2         60

Calcium       10.4  H       8.5 -10.1
Alk Phos      56 -      50 -136


X-ray clear, ultrasound clear


Ordered 50,000 iu 1x a week plus daily 2000.  Told to stop taking calcium suppliments.

I told them I don't take calcium supplements or any vitamins or supplements and do not like milk or ice cream.  Only dairy products is low fat milk in Latte and once a day Activia and cheese on salad.  Started taking supplements.

Two weeks later more labs and I insisted on on a PTH level.
1/27/11
FT4, TSH, PTH wCA   u24ca

ionized CA     1.38  H   1.04 - 1.36
FT4   .9
TSH    1.04

PTH w/CA
PTH Intact       57
CA                  9.4


UR Creatinine    58
Ur Creantinine -24 hr    1.1  

Ur CA              8.9
Ur  CA 24       170

Now I am sent for CT w/ and w/o contrast, colonoscopy, Pap & Pelvic - all which come back normal.


2/17/11

D2            33
D3             16
D2D3  tot    49

Creatine           1.2  H           .6 - 1.00
eGFR               51   L          

CA125                    5

FSH                       47.5      
Tot Test.             .2
Free Test             .37

Intact  PTH           47
Ca                        10.2      H            8.6 - 10.1    

Told I was menopausal and to take OTC soy products and continue Vit D supplements

Done with 12 weeks of Vit D and have been taking Estroven (has very little calcium added 50 mg.)
Where should I go from here?  The only tests I have not had is a intra pelvic ultrasound and  a mammogram.  Have asked for another CA, PTH and Vit D level tests.



RayLee

[Raylee505]

Thank you!

If this is mild I so feel sorry for the ones with higher lab values. I really can't imagine and even my family is so worried as I'm normally very active.

Have made an appt with an Endo.

Raylee

[Mark Lupo, M.D.]

Looks like primary hyperparathyroidism to me, although not an easy diagnosis to make and it appears to be early and mild.  If the calcium is high, the PTH should be low (usually <20-30).  In the case of two calcium and one ionized calcium readings that are elevated and PTH levels in the 40s-50s along with normal 24h urine Ca, the diagnosis is most likely primary hyperparathyroidism.