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25th July 2023
A 72-year-old man presents to the Acute Medical Unit with right thigh pain for several months.
A 72-year-old man presents to the Acute Medical Unit with right thigh pain for several months. It is now waking the patient up at night. There are no worsening or relieving factors, and symptoms have not improved with oral analgesia. There is no history of any trauma. Routine blood tests are taken:
| Haemoglobin | 135g/L (135-180g/L) |
| White Cell Count | 8.0 x10⁹L (4.0-11.0 x10⁹L) |
| C-reactive Protein | 7 mg/L (<10 mg/L) |
| Adjusted Calcium | 2.39 mmol/L (2.1-2.6 mmol/L) |
| Phosphate | 1.0 mmol/L (0.8-1.4 mmol/L) |
| ALT | 20 iU/L (3-40 iU/L) |
| ALP | 324 iU/L (30-130 iU/L) |
| Vitamin D | 51 nmol/L (>50 nmol/L) |
What is the most likely diagnosis?
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