Question

A 55 years old woman with left hip and low back pain, had insidious onset which was increased over time, fatigue, headaches attacks with occipital localization associated with dizziness and intracranial pressure.
Laboratory findings reveals: normocalcemia, hypophosphatemia, normocalciuria, hyperphosphaturia, normal serum parathyroid hormone level, 25-hydroxy vitamin D level decreased (19 ng/ml) and alkaline phosphatase level increased (572 U/l). The bones X-rays and computed tomography of the left femur showed marked thickening and sclerosis of cortical bone with small subchondral cystic lesions.

Discuss laboratory findings depending on the biochemistry results.
what is the diagnosis of this case?
what further laboratory tests should be done?

Answer 1

The laboratory findings reveals that the patient has a very low level of serum phosphate and vitamin D levels .Along with this is phospahte is excreted in the urine.The alkaline phosphatase levels are also increased

The diagnosis of this cases is Paget disease or Paget disease of bone .The symptoms like sudden onset of pain in hip and low back , increased fatigue, headache, dizziness and intracranial pressure , normal calcium,decreased phosphate in blood with decreased vitamin D and increased alkaline phosphatase are typical markers of this disease.

The other test which may be required are

• Bone scan or DEXA scanto identify any deformity or abnormal growth in the bone
• Biopsy to confirm the disease