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Just to add to Mohammad's list - if haematological indices are suggestive
and given hypogammaglobulinamia, don't forget about non-secretory myeloma.
Could try measuring beta-2-microglobulin if this is a possibility.

Steve Davis
Royal Glamorgan Hospital.

> -----Original Message-----
> From: Mohammad Al-Jubouri [SMTP:[log in to unmask]]
> Sent: Friday, November 28, 2003 4:33 PM
> To:   [log in to unmask]
> Subject:      Re: Severe hypercalcemia
>
> Non-PTH mediated severe hypercalcaemia ?cause
> ?malignancy-induced ?granuolmata (sarcoid, T.B,
> histoplasmosis)-related ?excess vitamin D (over the
> counter medicines), check ACE and vitamin D levels.
>
> regards
>
> Mohammad
>
>  --- "Dr. Ihssan Bouhtiauy" <[log in to unmask]>
> wrote: > We have a 66 old female, presenting vomiting
> and
> > diarrhea over several
> > months.  She has severe rheumatoid arthritis treated
> > with Plaquenil and
> > steroids.
> > She had thyroidectomy and apparently was
> > hypoparathyroid and neede
> > Calcium supplment but not active Vit. D
> > she is having severe hypercalcemia since several
> > months,
> > The results are:
> > TSH    4.45 (.5-5.0)
> > PHT    0.5 (1.6-6.9)
> > Urea    11.4 (1.6-6.9)
> > Creat.    404 (44-97)
> > Alb    34 (35-50)
> > Prot    59 (66-87)
> > Ca    4.6 (2.10-2.55)
> > Pi    1.45 (.87-1.52)
> >
> > Alc Phos.    normal
> > Bence jones     neg.
> > Electrophoresis:    hypogammaglobulinemia
> >
> > Any ideas?
> >
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> =====
> Dr. M A Al-Jubouri
> Consultant Chemical Pathologist
>
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