Clinical Case 5.4

A 28-year-old Asian woman from East Africa was admitted for investigation of suspected aplastic anemia. She was barely able to walk and was brought by wheel chair to the ward. A history revealed that she had delivered a normal baby a few months previously. She was thought to have aplastic anemia and had been treated with repeated blood transfusions. She complained of aches in her hips and was noted to have a severe proximal myopathy (weakness of the muscles around her hips). Her serum calcium was 1.96 mmol/l (NR 2.2–2.6 mmol/l), serum phosphate 0.66 mmol/l (NR 0.8–1.4 mmol/l) and albumin of 37 g/l (NR 38–48 g/l). Her serum creatinine was normal but she was noted to have a marked hyperchloremic acidosis (serum chloride 114 mmol/l (NR 99–109 mmol/l), serum bicarbonate 19 mmol/l)). The serum concentration of the bone isoform of the enzyme alkaline phosphatase (that is involved in mineralization) was markedly elevated at 1239 IU/l (NR 30–120 IU/l). X-rays of her hips showed marked deformation of the hip joint sockets on both sides and those of the lumbar spine osteopenia and osteoporosis. Detailed history taking revealed that she had become so weak during pregnancy that she had been unable to leave the house. Her only other symptom was of recurrent loose bowel motions that had become more marked during pregnancy.

From: Chapter 5, The parathyroid glands and vitamin D

Cover of Endocrinology
Endocrinology: An Integrated Approach.
Nussey S, Whitehead S.
Copyright © 2001, BIOS Scientific Publishers Limited.

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