Vit. D and Calcium High: High 1, 25-Dihydroxy D, High Total Calcium, Normal PTH

[Marc61]

Hello,
Hoping you can help.  I had some blood work done for fatigue/confusion/dizziness/disorientation.

PTH: 20 (normal)

Albumin 5.1 (high normal)

Calcium: 10.3 (H) (consistently high for past year (9.9 - 11.1)

Ionized calcium: 5.4

Vit. D 1, 25-Dihrdroxy:  68 (H)

Vit D. 25-OH/D3, Total: 59

Cortisol:  10.1 (8 a.m.)

The ENDO noted that this she was worried about the high combination of the 1,25-Dihydroxy D and high Calcium.  However, she noted that this was not related to thryoid disorder and could be Sarcoidoisos or a cancer problem.  

Questions:

1)  The ENDO noted that is it very difficult to get false high 1,25-Dihydroxy D since this is the final hormone version of D and is tightly controlled and high results are unusal in the absence of a problem.  Thoughts?

2) Should I be concerned about these results for Vit. D/Calcium and the fact that my Calcium floats high frequently?

3)  The ENDO said not to worry about the cortisol but I am always faitgued my cortisol is always on the very bottom end of acceptable....Should I continue to look at cortisol as a problem?

Thank you!

[Marc61]

Forgot to include my age/gender.  37 / male.

[Marc61]

Thank you for your comments.  Appreciated.  The ENDO noted that she wanted to look at ACE next and repeat the Vit. D 1,25-D, even though this is usually reliable. She also noted a chest CT to rule out lymphoma.   I will also look at the other labs that you note.  Thanks again for your help.  

[estrelinha]

Sorry didn't see PTH, it's normal.

[estrelinha]

I think you ENDO knows what he's doing, what about the calcium levels in urine?, the concern about VitD/calcium is hypervitaminose of Vit D.  I would look too for Sarcoidosis or other granulomatous disorder (reason for Vit. D 1, 25-Dihrdroxy:  68 (H) only)
Did he tested for ACE (angiotensin converting enzyme)? how about phosphate (PO4)? Did you tested for circulating PTH? I would still look for cortisol too (just to be sure). I think your ENDO is looking for the right points, and with tis analyses he/she will ask for more specific tests.