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Published byNorma Wilson Modified over 9 years ago
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CASE 2 49 yo man HIV+ since 1993 CD4 Nadir 120/7% Smoker of 45 pack years
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CASE 2 DATEREGIMENCD4Viral Load 1994AZT200------------- 1995AZT/ddI210------------- 1996AZT/3TC/SQV220------------- 1997-04d4T/3TC/NFV/NVP240<50 2004-12AZT/3TC/ABC/NVP270<50 2012ABC/3TC/NVP/RGV330<40 Antiviral History
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CASE 2 2012 Depression x yrs Fatigue x yrs Arthralgia/Bone pain
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CASE 2 DATECaIon. Ca (1.15-1.35) P04iPTH (1.3-8.2) VIT D 25(0-200) 1,25(39-193) Albumin TSH 05/122.79------0.6 7 ------ 49 06/122.871.560.7 2 1.670/33------1.22
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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
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CASE 2 June 2012 Of note, drinks 4L of milk daily!!!! On Ranitidine for GERD TOLD TO STOP MILK
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CASE 2 DATECaIon. Ca (1.15-1.35) P04iPTH (1.3-8.2) 06/122.871.560.721.6 07/122.671.500.64---------
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CASE 2 Felt much less tired with decreased arthralgia/bone pain when milk consumption eliminated
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CASE 2 DATECaIon. Ca (1.15-1.35) P04iPTH (1.3-8.2) 07/122.671.500.64--------- 08/122.781.530.571.9
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CASE 2 Further Workup Serum/urine immunelectrophoresis – normal CT Chest/Abdo – Normal
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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)
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CASE 2 Diagnosis ?mild primary hyperparathyroidism exacerbated by excessive milk consumption
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