Primary hyperparathryoidism vs. vitamin D deficiency

[1280]

Hi Dr. Lupo,

I apologize for the multiple postings. I have had hypercalcemia since January (Ionized calcium ranging from 1.39 to 1.47 mmol/l, normal range of 1.15-1.35).  My PTH has always been in the normal range (ranging from 2.4 pmol/l to 5.9 pmol/l generally at the higher end, the normal for my lab is 1.0-6.4 pmol/l) I have had a sestamibi scan that didn't reveal anything.  My urine calcium has also been elevated on at least one occasion (8.1 mmol/day, normal is up to 7.5 mmol/D).  I just got results for a bone scan and have been told that I have osteopenia.  I also have low vitamin D (not sure if it is 25 OH or 1,25).  I have been having bone pain for quite a long time, and other symptoms including anxiety, fatigue, chronic cough (my thought was GERD), and I generally don't feel well. I am a 26 year old male.  I also have crohn's disease and have had approximately 2 feet of terminal ileum ressected.  I am concerned that the low vitamin D levels will get blamed as the primary cause of my problems.  What is the most likely diagnosis?

Thanks

[Mark Lupo, M.D.]

primary hyperpara -- if the main problem were low vit d, the calcium would be lower....

[1280]

I forgot to mention I have had adequate dietary vitamin D, I usually drink at least 4 litres of fortified milk per week, and have had adequate sun exposure.