A 9 .5 year-old boy complains of recurrent and frequent attach of bone pain for more than 3 months duration with increasing during the day, not at night, didn't awake him from sleep and increasing gradually during the day, which is undetermined, sometimes in the head, in the shaft of the thigh, or in the figures and uni or bilateral. his growth slightly above 95%. His complete blood picture with blood film shows normochromic normocytic with no anemia, no abnormal cells, and other cells quite normally. his Alkaline phosphatase blood sample is normal, his calcium blood level is normal, his Vit D level is normal, and his thyroid hormone, TSH< free T3, T4, is normal. his bone age x-ray matches age 11 years which is within normal.
Note 1- he has no sign of giantism.
2- no growth hormone analysis has been done yet.
3- very few secondary sexual characteristics appeared otherwise, genitalia normal?
What could be the possible diagnosis?
What are other investigations that should look for to reach the diagnosis?
What should do to relieve the pain as he is now continuously on acetaminophen ( paracetamol) which response partially to it?
Excellent presentation of the case. if the pain is subjective may be related to psychological causes as mentioned migratory. but if the objective may be associated with the growth of bone. need further assessment of the hormonal analysis—osteoclast osteoblast function test.
Ziad Hazim Deleme Thank you for your nice and informative answer.
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