BOF: 36
A 26-year-old female presents with a history of diarrhoea
and loss of weight.
She also complains of recurrent mouth ulcers.
Investigations
Hb 1.0g/dL
MCV 101 fl
MCHC 32 g/dL
WBC 5.7 x 109/L
Platelets 280 x 109/L
Urea 4 mmo/L
Creatinine 105 mmol/L
Sodium 138 mmol/L
Potassium 3.9 mmol/L
Corrected calcium 1.8 mmol/L
Phosphate 0.7 mmol/L
In this patient which one of the following would you
expect?
a)
Hypoparathyroidism
b)
Pseudohypoparathyroidism
c)
Pseudopseudohypoparathyroidism
d)
Hyperparathyroidism
e)
Secondary hyperparathyroidism
Answer: e)
The patient has hypocalcaemia. If the hypocalcaemia were
due to hypoparathyroidism one would expect the phosphate level to be high. The
fact that the phosphate level is low would suggest that there is secondary
hyperparathyroidism.
With the history of diarrhoea, loss of weight and mouth
ulcers and the finding of a macrocytosis one would suspect that the patient
has coeliac disease with malabsorption resulting in vitamin D deficiency and
folic acid deficiency.
Revision Tip
Revise hyperparathyroidism and hypoparathyroidism
KEYS to SUCCESS in Medicine page 30-33
