Question

a 32 - year - old female patient presents with elevated alkaline phophatase, elevated sodium, elevated calcium, and elevated phosphorus. with this information what is your working diagnosis?
a) bone pathology
b) hyperparathyroidism
c) multiple myeloma
d) hypoparathyroidism

Explanation:

• Bone pathology: Alkaline phosphatase is an enzyme found in high levels in bone. Elevated alkaline phosphatase along with elevated calcium and phosphorus can be indicative of bone - related issues. For example, in conditions like Paget's disease (a bone pathology), there is increased bone turnover which can lead to these changes.
• Hyperparathyroidism: In hyperparathyroidism, parathyroid hormone (PTH) is over - secreted. PTH acts on bones to release calcium. However, in primary hyperparathyroidism, phosphorus is usually low (because PTH promotes renal phosphate excretion). So this option is less likely.
• Multiple myeloma: In multiple myeloma, there can be bone involvement. But typically, there are other manifestations like monoclonal protein in the blood or urine, and the pattern of laboratory values (while there can be hypercalcemia) does not typically match the combination of elevated alkaline phosphatase, calcium and phosphorus in the same way as bone pathology.
• Hypoparathyroidism: In hypoparathyroidism, calcium is low (because PTH is needed for calcium homeostasis) and phosphorus is high (opposite of hyperparathyroidism). So this option is incorrect.

Answer:

a) Bone pathology