Analysis of Calcium Homeostasis With Laboratory Results

Question: Case study 24 (1)- Part 1 1. Which laboratory results are abnormal? 2. What is the presumptive diagnosis for this patient? The differential diagnosis? WHY? 3. What treatment is indicated for this disease? Case study 24- part 2 (4) 1. What diagnostic possibility is suggested from the initial laboratory results? 2. This patients differential diagnosis includes two diseases. What are they? 3. Is her renal function related to either of these two diseases? 4. How should this patient be treated? Answer: Case study 24 (1)-Part 1 1: Which laboratory results are abnormal? Sol 1: The laboratory results that are abnormal in the mentioned case study are Intact PTH level which is higher than the normal range, Urinalysis RBCs/HPF, which is also in the higher range, and abnormal urine calcium level greater than the normal range. Though the calcium level is also at the slightly higher range of 11.1 mg/dL but this level is asymptomatic at this level. 2: What is the presumptive diagnosis for this patient? The differential diagnosis? WHY? Sol 2: The most common presumptive diagnosis for this patient is a bladder infection, urinary tract infection, or kidney stones. However, the less common diagnosis for this patient could be kidney or bladder cancer, kidney filtering disorders, the presence of cysts in the kidneys, narrowing scars also called as stricutures, or other abnormalities related to the ureters. The differential diagnosis for this patient, however, can be hyperparathyroidism, as the symptoms are also related to hyperparathyroidism, as well as, the lab results also shows the high level of Intact PTH hormone, urine calcium, as well as, high level of urinalysis. 3: What treatment is indicated for this disease? Sol 3: Removal of the parathyroid glands that are enlarged or having tumor by surgical procedure is the most common method of treating primary hyperparathyroidism. However, various drugs belonging to the class of Calcimimetics, Bisphosphonates, as well as, hormone replacement therapy can also be used as a symptomatic treatment of hyperparathyroidism (Green Ali, 2009). Case study 24- part 2 (4) 1: What diagnostic possibility is suggested from the initial laboratory results? Sol 1: As the patients calcium level is at borderline and is slightly low from the normal range it suggests of hypocalcemia. The diagnostic possibility for low levels of calcium can be abnormal functioning of the parathyroid hormone, vitamin D deficiency, magnesium depletion, or hypermagnesemia. 2: This patients differential diagnosis includes two diseases. What are they? Sol 2: The two differential diagnosis present in this case is hyperparathyroidism, as well as, vitamin D deficiency. As the further evaluation of this woman showed the evidence of higher value of PTH than the normal range and a very low level of vitamin D as compared to the normal range suggestive of presence of these two diseases in the patient. 3: Is her renal function related to either of these two diseases? Sol 3: Yes, the renal function of the patient is related to both the hyperparathyroidism, as well as, vitamin D deficiency. Low levels of vitamin D in the individual are more likely to cause albuminuria, which is the indication of the kidney damage. Moreover, the hyperparathyroidism results into the increased secretion of calcium in the blood, which in turn increases the calcium in urine thus increasing the chances of kidney stones formation. 4: How should this patient be treated? Sol 4: As the patient has a relatively low levels of vitamin D in her body indicating vitamin D deficiency, so starting her on vitamin D supplements is the foremost regimen of the treatment. She can be started on the high dose of vitamin D3 supplements. For hyperparathyroidism treatment, the patient can be started on Calcimimetics, Bisphosphonates, as well as, hormone replacement therapy. Moreover, as she is having low levels of calcium also and is lactose intolerant, she can be placed on some calcium supplementation therapy (Brndstedt, Almquist, Manjer, Malm, 2012). References Brndstedt, J., Almquist, M., Manjer, J., Malm, J. (2012). Vitamin D, PTH, and calcium and the risk of prostate cancer: a prospective nested casecontrol study.Cancer Causes Control,23(8), 1377-1385. https://dx.doi.org/10.1007/s10552-012-9948-3 Green, E. Ali, Z. (2009). Flank pain and haematuria.BMJ,339(dec30 1), b5443-b5443. https://dx.doi.org/10.1136/bmj.b5443