tag:blogger.com,1999:blog-4574215170182412215.post2666827454048657355..comments2009-12-12T20:28:42.179-05:00Joel Topfhttp://www.blogger.com/profile/03706593315253399631noreply@blogger.comBlogger7125tag:blogger.com,1999:blog-4574215170182412215.post-31532226366459099602009-12-12T20:28:42.179-05:002009-12-12T20:28:42.179-05:00nice post, very informative!Xoxohttp://exploringwomanhood.blogspot.com/noreply@blogger.comtag:blogger.com,1999:blog-4574215170182412215.post-18944503328230645672009-12-12T20:28:04.475-05:002009-12-12T20:28:04.475-05:00This is a very helpful post. Glucose count is important for us to be aware. This may lead to diabetes. Keep posting!Bryanhttp://bryanking.net/noreply@blogger.comtag:blogger.com,1999:blog-4574215170182412215.post-38854226342465917212009-12-10T14:25:01.276-05:002009-12-10T14:25:01.276-05:00Joel I think it is a combination of factors. I think this patient has lower bone buffer capacity for the administrated calcium which is he was absorbing more avidly by the increase in vitamine D. This might be the result of a tertiary hyperpth. Thus I think it is rather a combination of factors. With such a high calcium one would expect the PTH to be undetectable.<br />Alternatively the patient might have adynamic bone disease despite hyperparathyroidism. This might be the result of alumunum toxicity on the bone which he might have used for some while in his dialysis days. Also a combination of factors.<br /><br />Does anyone have another explanation?Rene C Bakker, The Netherlandsnoreply@blogger.comtag:blogger.com,1999:blog-4574215170182412215.post-37908164009555330812009-12-08T22:21:15.641-05:002009-12-08T22:21:15.641-05:00We all can learn from your case. Fire away.Joel Topfhttp://www.blogger.com/profile/03706593315253399631noreply@blogger.comtag:blogger.com,1999:blog-4574215170182412215.post-22144442355749415092009-12-08T20:24:05.614-05:002009-12-08T20:24:05.614-05:00Interesting enouth, I saw my highest Ca ever: 20!!<br /><br />I can discuss this case here if u like.Nishanthttp://www.blogger.com/profile/06385175032820758531noreply@blogger.comtag:blogger.com,1999:blog-4574215170182412215.post-21349143886512936242009-12-08T16:22:08.025-05:002009-12-08T16:22:08.025-05:00Rene, do you think the PTH is driving the hypercalcemia? I don&#39;t. I agree that he probably has some autonomous parathyroid tissue but I doubt it is clinically significant. Its hard for me to beleive that a PTH of 3 is a significant factor in his high calcium.Joel Topfhttp://www.blogger.com/profile/03706593315253399631noreply@blogger.comtag:blogger.com,1999:blog-4574215170182412215.post-84566950546341456532009-12-08T12:41:42.089-05:002009-12-08T12:41:42.089-05:00One would expect the serum PTH not measurable with such a high calcium concentration. I expect that this is not just overdosing of calcium. I would suggest that this Tx pt has a tertiary hyperpara which is somewhat supressed now by the high serum Ca. Remeasure the PTH when the calcium is normal. It will probably show a high value.Rene C Bakker, The Netherlandsnoreply@blogger.com