Parathyroid or Multiple Myeloma

[janderson32]

I've been having some basic bloodwork checked over the past couple of years.  Last year, my PCP came to the conclusion that I may have a case of Primary Hyperparathyroidism.  After this conclusion, I was referred to an endo.  I've since moved on to a second endo, and at this time, she thinks that I just need to have the bloodwork checked every so often.  All of the bloodwork conducted by my PCP indicates Primary Hyperparathyroidism, but the bloodwork done by the second endo scares me and makes me wonder if it is multiple myeloma.  I have read over Dr. Norman's sight numerous times and have learned way more than I ever cared to about the parathyroid glands.  I wanted to post my labs out here to get other opinions, especially Dr. Lupo's.  

Labs listed are in order of oldest to newest, starting in May of 2009.  I've had a negative parathyroid scan (I know you can more than likely have a false negative).  All other bloodwork has been normal (i.e. WBC, RBC, normal serum protein, etc).  Creatine has been slightly elevated, but never outside normal range.  

Everything I've read said this should point to Primary Hyperparathyroidism, but the one value of 21 for the PTH intact scares me.  I will note that this blood sample was taken very late in the day, where nearly all others have been done around midday.

Calcium
10.5 on scale of 8.7 to 10.4
10.8 on sclae of 8.7 to 10.4
10.9 on scale of 8.7 to 10.4
11.0 on scale of 8.7 to 10.4
10.6 on scale of 8.7 to 10.4
10.0 on scale of 8.5 to 10.5
10.0 on scale of 8.5 to 10.35
10.1 on scale of 8.7 to 10.4

PTH Intact
63.2 on scale of 11.1 to 79.5
72.9 on scale of 11.1 to 79.5
54.2 on scale of 8.2 to 83.5
21.8 on scale of 12.0 to 65.0
73.5 on scale of 11.1 to 79.5

Ionized Calcium
1.34 on scale of 1.11 to 1.30

Urine Calcium
313 on scale of 100 to 250

[janderson32]

Thank you so much for responding to my questions Dr. Lupo.  I truly do appreciate it.  Should I be having these blood tests conducted at a certain time of the day or is that not important?  Over the course of this situAtion, I've had labs drawn an analyzed at three different facilities and I think my mind is starting to play tricks on me that all of the higher values I've had (I.e. 50 and up) are an accident.  Or is there a certain type of PTH measurement I should be having done (other than intact)?  I feel as though I can't get a doctor to make a clear diagnoses without a high PTH level with a high calcium level.  Would you be of the opinion just to monitor?  Should I have any other tests done?  Or should I search for a doctor to do the operation with based on all of the labs I have had completed to this point?  

Thanks again for your time.  

[Mark Lupo, M.D.]

This is most consistent with primary hyperparathyroidism.
With high calcium due to myeloma or other malignancy, we see consistently low PTH levels.