Friday, August 28, 2015

A 50 Year Old Woman Presents With Long Standing Bone Pains.

A 50 year old woman who had a history of long standing body pains and aches , was found to have hypercalcemia on her blood reports. On further workup she also had high levels of parthyroid hormone. On further questioning she mentions that she frequently gets a stomach upset, with abdominal pain and constipation. She feels lethargic and has a feeling of lack of energy for a long time.

This patient was diagnosed to have Hypercalcemia secondary to Hyperparathroidism .



Case Discussion;

Hypercalcemia is a condition in which the calcium levels in the blood is above normal limits. By far the most common cause of hypercalcemia is hyperparthroidism, from the over activity or adenoma of parathroid glands.


Clinical features: Early in the course when there is mild hypercalcemia, patients may have no or very mild symptoms. Too much calcium in the body can weaken the bones, can lead to kidney stones and may interfere with the normal functioning of the brain.
Signs and symptoms include:

  • Lethargy and weakness
  • Confusion
  • Polyuria and nocturia
  • Dehydration
  • Renal stones
  • Constipation
  • Nausea
  • Anorexia
  • Abdominal pain
  • Gastric ulcer
  • Bone pains. 
Complications: Long standing hypercalcemia may lead to:

1. Osteoporosis: when hypercalcemia is secondary to hyperparathroidism , high levels of parathyroid hormone stimulates the bone to release calcium into the blood. this leads to thinning and weakening of the bone, which may result in fractures on minor trauma, and loss of height. 

2. Kidney failure: Severe hypercalcemia can slowly damage the kidneys leading to kidney failure. 

3. Heart Arrhythmia: High levels of calcium ion the blood can alter the electrical impulses conducted in the heart muscle and may lead to arrhythmias. 

ECG characteristic of hypercalcemia is shown below:


Diagnosis: Since hypercalcemia may cause few or no symptoms it is sometimes diagnosed on routine blood work. Once found the underlying cause should be identified by doing the relevant workup including parthyroid hormone levels, urinary calcium excretion, thyroid function tests, imaging tests of bone and lungs etc. 

Treatment: The goal of therapy is to identify the underlying cause and treat accordingly. 
1. General management includes proper hydration which helps in preventing the formation of renal stones. 
2. Immobilization aggravates hypercalcemia, whenever possible weight bearing physical activity should be encouraged. 
3. Patients with calcium levels less than 12 mg/dl and with no symptoms does not need any specific treatment.
4. Patients who have high levels above 14 mg/dl along with symptoms of confusion may need aggressive treatment. 
5. Reduction of dietary calcium and vitamin D intake is effective as it helps in decreasing calcium absorption from the intestinal tract.
6. Bisphosphonates inhibit osteoclastic bone resorption and are effective in the treatment of hypercalcemia due to conditions causing increased bone resorption.
7. Prolonged hypercalcemia due to hyperparathyroidism may need surgical removal of parthyroid adenoma or one or more parathyroid glands. 

2 comments:

  1. Hello, my name is Betty. i was diagnosed of HIV virus 4 years back. Before then, i was dating this Derrick guy. we had something great going on. Our love life only lasted for 8 months. the sixth and seven month of our relationship, i began feeling very weak every now and then. But i never suspected anything until I kept on experiencing different symptoms like having sore throats, constant headache, body weakness e.t.c. I decided to go for a medical check up. I was tested HIV positive. when the doctor broke the news to me, it was as if my whole world had crumbled. it dawned on me then that Derrick has been lying to me. i was very mad to an extent i almost committed suicide. But there was nothing i could do, other than weep and weep. ever since then, i have been spending heavily on medications, going from one medical clinic or the other so I can look healthy. Though since i was a kid, i love herbs a lot. i take herbal tea with grandma while growing so i am quite familiar with herbs. early last year, i was on the internet and on a particular health blog, to check for herbal medication as alternative. I saw many comments and read many testimonies. Until i came across a particular testimony on how Dr.ugo cured a patient from herpes simplex virus using pure natural herbs. i reached out to the doctor because I also was thinking Herpes had no cure. I told him about my HIV status.He encouraged me not to panic that he will help me get my deliverance. he prepared some herbs and sent them to me. The herbs were in four 70ml bottles and I took them morning and night. i used as he directed, and in less than three weeks, i started having appetite to eat plenty of food and i gained back my strength. the fourth week,I consumed all the herbal meds. He encouraged me to go for a test which i did. This time, the result was negative. I quickly contacted the doctor and informed him of the news. I immediately asked him to prepare for Derrick too. He did and sent it. Today, me and Derrick are HIV free. All thanks goes to God Almighty for healing us through Dr.Ugo. if you are having any kind of sickness at all, Dr.Ugo is the right person to talk to and i assure you, you will be glad you did. His email: ugoherbalhome@gmail.com you can also write him on WhatsApp +2348104990619.

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  2. Nice blog
    Have been totally convinced that HIV,and many others dangerous diseases can be best cured using the Herbal Medicine. Dr.Akpu the great and powerful herbalist cured me with his Herbal remedy. I'm Linda,15 years from Texas. I was born with HIV. I lost parents at my teenager age when I was 4th. I had to grew up with my mum only Sister, whom I loved so much. She was so worried about my life as my condition was her mature problem in life. I had taken lots of antiviral treatment to get ride of the virus not believing what there said HIV has no cure. I was on the internet when i came across blogs of testimony about a lady who where cured of a 7 years diagnose of Herpes by this powerful Herbalist, Dr.Akpu.I wrote down his mail @ Dr.akpupowerherbscenter@gmail.com
    I told my Aunt,luckily it was the same Dr,we where referred to few months back by my pastor in church whom members have being testifying about of his cure We did contacted him and explained my problem to him.He prepared the medicine and sent to me with details of how to use and apply. After a while, I began to feel more strong than never before, I felt so lucky and happy when my Doctor congratulated me that he could found no HIV virus again in me. I knew I was free cos my body was so strong. His herbal medicine should have saved my parents life, i said!
    Thanks so much for reading my article, you should share your testimony if you have cure as well
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