PLAB03-147

Edith is 69 years old and was recently seen at the GP surgery with malaise and generalised bone pains. She denied any other systemic symptoms including night sweats, weight loss, pain at night, reduced appetite, or changes to her bowel habits. Detailed examination did not reveal any obvious cause for her symptoms and thus blood tests were requested.

Past medical history includes Hypertension, Hypercholesterolaemia, Asthma and Glaucoma. In addition, two years ago she had a surgical admission for renal stones. Her current medication includes Amlodipine, Atorvastatin, Salbutamol inhaler and Latanoprost eye drops. She sees you today for the results of her blood tests.

Hb 129 g/dl
Vitamin D 30 nmol/L
White blood cell count 7 x 109/L
Liver function tests – normal
Platelets 200 x 109/L
Parathyroid hormone 11 pmol/L
Corrected Calcium 3.35 mmol/L
ESR 3 mm/hr
Alkaline phosphatase 270 U/L
Phosphate 0.7 mmol/L

What is the next most appropriate course of action?

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