General Information

• CL• 15 year old, male• Student• Manila• Informant: patient and grandmother• Reliability : good

Shortening of Height

Chief Complaint

History

1 yr 6 mos (April 2012) prior to consult• Slipped, “disconnected right hip/leg”• No consult• Shortening of height; difficulty in ambulation; painful hips, knees, lower ribs

2 weeks (September 2013) prior to consult• Consult with Ortho, Pedia-Hema-Onco• Labs done, given Calcium supplement, referred to Pedia-Endo

SKELETAL SURVEY

SONOGRAPHIC FINDINGS

IMPRESSION

• Upper limits in kidney size for this age group with diffuse parenchymal changes

• Hydronephrosis Grade I, bilateral, more pronounced at the left

• Cystitis

Other Diagnostic Exams

• Laboratory: – PTH: 3329 pg/ml (11-54 pg/ml)– Ionized Ca: 1.86 mmol/L (1.1-1.35 mmol/L)– Phos: 2.62 mg/dL (2.4-4.7 mg/dL)– ALP: 3202.60 u/L (40-129 u/L)

Hyperparathyroidism

Impression

Differential Diagnosis

• Hyperparathyroidism• Renal Osteodystrophy• Osteoporosis, Osteomalacia• Rheumatic diseases (RA, AS)