Case study 6 George: an unquenchable thirst

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Case study 6

George, an unquenchable thirst.

George was a thirty eight year old man enjoying a holiday in Spain who developed thirst and polyuria. He had no other symptoms. When he arrived home he consulted his doctor and had a urine test. There was no glycosuria. Subsequently, a blood sample was taken and the results were obtained:

Serum: Calcium 3.24 mmol/l

Phosphate 1.20mmol/l

Alkaline phosphatise 90 iu/l

Urea 10.0 mmol/l

Creatinine 150 mmol/l

George was a non smoker and was admitted to hospital for investigation. He had previously been well, apart from some joint pain and a painful rash on his legs several months before which has resolved spontaneously. A chest radiography showed some increased hilar shadowing but was otherwise normal. No bony abnormality was seen on skeletal radiographs.

George was slightly dehydrated and was given an intravenous saline infusion. Despite a good dieresis, the serum calcium was unchanged. He was then given hydrocortisone, 40mg, three times daily, and a week later the serum calcium was 2.80 mmol/l. At this time, the result of a PTH assay on blood taken on admission became available; no PTH could