Case of the Month: Pediatric ESAP

esap 2017

This issue highlights Pediatric Endocrine Self-Assessment Program. Test your clinical knowledge and prepare for your exam. Available on the online store.


You are asked to evaluate an 18-year-old girl because of concerns about hypocalcemia. At her recent precollege physical she described a several month history of fatigue and intermittent right upper-quadrant pain.

Laboratory test results:

  • Calcium = 7.8 mg/dL (8.5-10.5 mg/dL) (SI: 2.0 mmol/L [2.1-2.6 mmol/L])
  • AST = 1480 U/L (10-40 U/L) (SI: 24.7 µkat/L [0.2-0.7 µkat/L])
  • Albumin = 2.5 g/L (3.5-5.5 g/L) (SI: 25 g/L [35-55 g/L])
  • PTH = 20 pg/mL (16-87 pg/mL) (SI: 20 ng/L [16-87 ng/L])
  • Total 25-hydroxyvitamin D = 16 ng/mL (20-80 ng/mL) (SI: 39.9 nmol/L [49.9-199.7 nmol/L])

Her medical history is notable for systemic lupus erythematosus, which has been well controlled with methotrexate.

On physical examination, she is a fatigued-appearing teenager with mild scleral icterus.

Which of the following medications is most likely to correct this patient’s laboratory abnormalities?

    1. Calcium
    2. Cholecalciferol
    3. Immunosuppressant therapy
    4. PTH
    5. Calcium and calcitriol


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