indistinct or absent. In children with rickets, the most significant finding among the bone changes is the presence of Looser’s lines (unmineralized osteoid)
– signs of vitamin D intoxication: hypercalcemia, hypercalciuria, increased or normal alk phos
– most common cause of primary hyperPTH is a single adenoma (80%)
– initial treatment of hypercalcemia is saline infusion with lasix
– osteomalacia tends to have an increased alk phos, muscle weakness, skeletal changes, and Looser’s lines
– the radiographic hallmark of osteomalacia is Looser’s lines
– distinguishing osteoporosis from osteomalacia – may require biopsy. Typically, there are no urine or serum abnormalities in osteoporosis. In osteomalacia, the serum calcium and phosphate may be low. Urine calcium is low. Alkaline phosphate is high.
– hemophilia does not cause secondary gout
– serum alk phos is high in osteomalacia, myositis ossificans, paget’s, and osteogenesis imperfecta
– CPK levels are increased in Duchenne MD and congenital myopathy
– Hypothyroidism is associated with cretinism (as a neonate), the child looks younger than chronologic age (hence puberty is delayed – they do not get precocious puberty!), growth is retarded, and secondary centers of ossification form late and may show fragmentation (beware of this diagnosis when bilateral femoral epiphysis look fragmented).