A 46-year-old female patient checks into the office. She has broken bones severa

Question

A 46-year-old female patient checks into the office. She has broken bones several times over the last couple of months, yet she maintains a lifestyle which does not include strenuous activities that could lead to these types of injuries. You perform some blood tests and receive the following results.

After reviewing her results, you come to a conclusion. What might be wrong with this patient and how does this diagnosis correlate with the symptoms presented by the patient?

Hormone TSH Prolactirn ACTH HGH LH FSH ADH Parathyroid hormone Calcitonin Cortisol Values 3.0 mlU/IL 15 ng/mL 42 pg/ml 0.01 ng/mL 5.6 IU/L 7.3 mlU/mL 4 pg/mL 97 pg/ml

Explanation / Answer

while other hormones seem to be in the normal range, Parathyroid hormone, calcitonin, and cortisol levels are the one which is out of their normal range.Normal ranges for these hormones are:

parathyroid hormone:10-65 pg/mL or 10-65 ng/L

calcitonin:less than 5.8 pg/mL (ng/L) in females

cortisol: 10 to 20 micrograms/deciliter (ug/dl) in the early morning (within one hour of the usual time of awakening), from 3 to 10 ug/dl at 4 PM, and are usually less than 5 ug/dl after the usual bedtime.

as seen above, parathyroid, which is a hormone which stimulates bone resorption ( release of calcium from the large reservoir contained in the bones. Destruction of bone by osteoclasts) exceeds its normal values.PTH binds to osteoblasts, the cells responsible for creating bone and inhibits their secretion of Osteoprotegerin (a hormone involved to inhibit osteoclasts).all this leads to decrease in bone density, making them weaker and more prone to breaking.

Also low levels of calcitonin( inhibits the activity of osteoclasts, which are the cells responsible for breaking down bone.has opposing the effects on parathyroid hormone thereby inhibiting of bone resorption. also activates osteoblasts thereby preventing fractures) may be a reason for the susceptibility of bone breakage.

A glucocorticoid like cortisol indirectly acts on bone by blocking calcium absorption which decreases bone cell growth. it increases bone resorption by stimulating osteoclastogenesis.Though its a slight increase but it has a profound effect on bone mineral density.

Thus during diagnoses and treatment, the above-mentioned hormones should be taken into consideration.

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