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 BOF 143

 

   

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BOF: 143

A 26 year old female was admitted with a history of muscle pains and feeling faint of several weeks duration. She also complained of abdominal pain and feeling nauseated and had vomited several times over the past few days. There were no past illnesses of significance she was not on any medication and the family history was unremarkable. She was a housewife and had 2 children ages 6 and 4 years and they were well.

On examination she looked thin, skin was  pigmented , pulse 90 beats per minute BP 90/60 lying , 70/40 standing heart sounds were normal , there were no murmurs , lungs were clear and abdominal examination was unremarkable .

Investigations

FBC and chest X-ray were normal

ESR 28 mm in 1st hour

Urea 9.2 mmol/L

Sodium 128 mmol/L

Potassium 5.4 mmol/L

Bicarbonate 19.4 mmol/L

Calcium 2. 9 mmol/L

Phosphate 0.9 mmol/L

Alkaline phosphatase 175 U/L

In this patient the most likely diagnosis is:

a)    Primary hyperparathyroidism

b)    Addisonís disease

c)     Myeloma

d)    Bone metastases

e)    Sarcoidosis

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