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Bones, groans, moans … and salivary stones?
  1. J R Paterson,
  2. M J Murphy
  1. Department of Biochemistry, Dumfries and Galloway Royal Infirmary, Dumfries DG1 4AP, UK
  2. Department of Clinical Chemistry, Derriford Hospital, Plymouth PL6 8DH, UK

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    A 46 year old man was referred to hospital by his general practitioner with abnormal bone biochemistry. He had presented with poor appetite, fatigue, myalgia, and backache. Serum calcium, corrected for albumin, was 2.63 mmol/litre (reference range, 2.12–2.62), serum phosphate was 0.85 mmol/litre (normal range, 0.7–1.4), and alkaline phosphatase was 367 IU/litre (normal range, 80–280). There was no history of previous fractures or of renal calculi. The parathormone concentration was raised at 19 pmol/litre (normal range, 1.3–7.5) and the urinary calcium to creatinine ratio was 0.375 (normal range, 0.085–0.65). Bone densitometry provided evidence of osteoporosis (T score, −3.05). Ultrasound of his neck revealed a solid lesion of low echodensity at the lower pole of the right lobe of the …

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