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A 61-year-old female diagnosed to have carcinoma of the left side with disseminated skeletal metastases (figure 1) 5 years back presented with worsening bone pains and fatigability for the past 6 months. She was earlier treated with palliative radiotherapy to the spine and had been on oral letrozole; this was followed by a palliative mastectomy. In addition, she received parenteral bisphosphonates for metastases. Clinical examination was unremarkable. Blood biochemistry showed elevated calcium 12.8 mg/dL (N: 8.3–10.4) with an alkaline phosphatase of 61 U/L (N: 40–125) and creatinine of 0.7 mg/dL (N: 0.6–1.2), 25 OH vitamin D of 26 ng/mL (N: 30–75 ng/mL) and elevated …
Footnotes
Contributors RB wrote the manuscript. AS, MJP and TVP reviewed, revised and approved the manuscript.
Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.