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CASE 2

CASE 2. 49 yo man HIV+ since 1993 CD4 Nadir 120/7% Smoker of 45 pack years. CASE 2. Antiviral History. CASE 2. 2012 Depression x yrs Fatigue x yrs Arthralgia/Bone pain. CASE 2. CASE 2. No family history of endocrine abnormalities No obvious cancer

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CASE 2

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  1. CASE 2 • 49 yo man • HIV+ since 1993 • CD4 Nadir 120/7% • Smoker of 45 pack years

  2. CASE 2 Antiviral History

  3. CASE 2 2012 • Depression x yrs • Fatigue x yrs • Arthralgia/Bone pain

  4. CASE 2

  5. CASE 2 • No family history of endocrine abnormalities • No obvious cancer • No ingestion of meds known to cause high calcium • No calcium supplements, vitamins, herbal remedies, OTC’s or calcium carbonate containing products

  6. CASE 2 June 2012 • Of note, drinks 4L of milk daily!!!! • On Ranitidine for GERD • TOLD TO STOP MILK

  7. CASE 2

  8. CASE 2 • Felt much less tired with decreased arthralgia/bone pain when milk consumption eliminated

  9. CASE 2

  10. CASE 2 Further Workup • Serum/urine immunelectrophoresis • normal • CT Chest/Abdo • Normal

  11. CASE 2 Further Workup • U/S Thyroid • Small nodule • No change in size with 3mos f/u • 24 hr urine for calcium • Elevated urinary calcium 8.6 mmole/l (1.2-6.2)

  12. CASE 2 Diagnosis • ?mild primary hyperparathyroidism exacerbated by excessive milk consumption

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