Since Maria has a high maximal oxygen uptake, she should have good endurance with little fatigue and pain during exercise. The fact that her muscles are not large but have good tone supports her statement that she frequently engages in endurance-type exercise. The normal concentration of creatine phos-

phokinase suggests that her skeletal muscles and heart may not be damaged, but further tests should be done to confirm this, particularly since she has a history of hypertension. The fatigue and muscle pain might simply be due to excessive workouts, but the high blood Ca2+ concentration suggests another possibility. The high blood Ca2+ could be responsible for her excessively high muscle tone; this inability of her muscles to relax might, in fact, be responsible for the pain and fatigue. Maria should therefore undergo an endocrinological workup (for parathyroid hormone, for example) to determine the cause of her high blood Ca2+ levels.

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