The 51st meeting: "A Bare-Bones Approach"


Ciao, this is Hakodate Ryohoku Hospital.
I'm Dr. Daisy.
Today we present an abstract of the CLINICAL PROBLEM-SOLVING article, “A Bare-Bones Approach”.
A 60-year-old woman with type 1 diabetes mellitus presented to her physician for a preoperative evaluation before undergoing cataract surgery. She had been feeling well except for mild fatigue.

The combination of anemia, hypercalcemia, and kidney disease is characteristic of multiple myeloma, but these conditions could also be related in many other ways.

Hypercalcemia can be classified as parathyroid hormone-dependent or PTH-independent; the latter classification is usually accounted for by malignant conditions, excessive ingestion of vitamin D or calcium, granulomatous disease, medication use, or endocrinopathic conditions.

The patient’s fatigue, sweats, and weight loss suggest a systemic disorder. The low level of PTH rules out hyperparathyroidism. Hypervitaminosis D due to ingestion of cholecalciferol or ergocalciferol is ruled out by the low level of 25-hydroxyvitamin D.

Sarcoidosis is characterized by dysregulated production of 1,25-dihydroxyvitamin D3. In activated macrophages, 25-hydroxyvitamin D is converted to calcitriol, and PTH levels are suppressed by the elevated calcitriol levels and hypercalcemia.

A measurement of serum 1,25-dihydroxyvitamin D3 level was omitted from the hypercalcemia evaluation but may have been informative.

The clinicians reached the final diagnosis of osseous sarcoidosis through an extensive evaluation, but they may have arrived at the diagnosis and treatment even earlier with a bare-bones approach.
Thank you for listening, ciao!

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