study_ing
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A 46-year-old Caucasian man presents with a history of fatigue and poor concentration for the last few months. Past medical history is significant for kidney stones and a treated peptic ulcer years ago. He has smoked 1 pack of cigarettes each day for the last 15 years. Review of systems was positive for bilateral hand pain for the past several months, which was not alleviated by ibuprofen. The patient denies taking any other medications. Physical examination is unremarkable. Thyroid function tests and blood glucose are normaI. The serum calcium is 11mg/dL and serum phosphorus is 2.6 mg/dL. Parathyroid hormone (PTH) is 800 pg/mL. Urine calcium is 425 mg/24 hrBilateral hand x-ray films are obtained. They show subperiosteal bone resorption and some cyst formation. What do these x-ray findings suggest
/ A. Hungry bone syndrome
/ B. Osteogenesis imperfecta
/ C. Osteitis fibrosa cystica
/ D. Osteomalacia
/ E. Paget disease of bone
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| robin082006
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A?
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| saadtazjam
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C?
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| luabe
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I think C
xray findings of osteitis fibrosa cystica include subperiosteal resorption with cyst formation
osteitis fibrosa cystica—the bony changes of secondary hyperparathyroidism. This affects ~ 50% of patients nearing ESRD. As GFR decreases below 25% of normal, phosphorus excretion is impaired. Hyperphosphatemia leads to hypocalcemia, stimulating secretion of PTH, which has a phosphaturic effect and normalizes serum phosphorus. This continuous process leads to markedly elevated PTH levels and high bone turnover with osteoclastic bone resorption and subperiosteal lesions. Metastatic calcifications, such as tumoral calcinosis, can occur. Radiographically, lesions are most prominent in the phalanges and lateral ends of the clavicles.
hungry bone synderome is rapid uptake of phosphate after treatment of osteomalacia, rickets, or postparathyroidectomy
while osteomalacia, will show renal wasting of phosphorus, and hypophosphatemia bone pain, weakness
this is a real tough one!! where did u get this question? sorry if i'm wrong...
and also, there is no mention of renal failure in the question...if this is the answer are we supposed to infer that?
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| study_ing
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guys , i m fusing step 1 qs to make step 2 qs!! that way we can do our share for those who havnt taken the first step.
luabe, ur right on target.
first look at the profile of the labs, and the dx will be primary hyper PTH. then even if u didnt know the radiographic features, the answer we'll guess is C
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| sheeezooo
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c 
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