doc_clotaire
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A 69-year-old female with a two-year history of asymptomatic hyperparathyroidism reports to her family physician with generalized anxiety and intermittent confusion. She wears a pacemaker for sick sinus syndrome and is otherwise healthy. Six months ago she had normal results on serum and urine protein electrophoresis, mammography, radiography of the chest, and ultrasonography of the neck. The immunoreactive parathyroid hormone level was five times the normal level and the ionized serum calcium level was increased.
Presently her serum calcium level = 12.6 mg/dL. CT scan of the head shows no abnormalities. The most appropriate next step in management is ?
A. Estrogen therapy
B. Low-calcium diet with oral phosphate supplementation
C. Oral diphosphonate therapy
D. Subcutaneous calcitonin therapy
E. Surgical exploration of the neck
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| Aashi
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E. Surgical exploration of the neck
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| robin082006
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D. Subcutaneous calcitonin therapy
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| CocaCola
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E - Surgical exploration of the neck... her calcium levels are high and she is symptomatic
Calcium over 12 needs surgery
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| chemamr
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I think it's E.
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| young_doc
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I go with C.
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| 92306
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E. Surgical exploration of the neck
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| Geroo
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I think E
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| doc_clotaire
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E is RIGHT
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| DrPak
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Shouldn't it be 'surgical removal' instead of 'surgical exploration'? An exploration means you look and act based on the findings. With primary hyperparathyroidism, the way to go is surgical removal, but the word 'exploration' threw me off.
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| DrVirgo
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I came across a similar question recently also and the explanation said:
Surgical intervention (parathyroidectomy) is needed for symptomatic hyperparathyroidism.
It also said:
Bisphosphonates and loop diuretics are used to treat symptomatic hypercalcemia.
But in primary hyperparathyroidism, there is BOTH INCREASED PTH AND INCREASED Calcium, so which treatment would be appropriate: Surgery or bisphosphonates?
I can post the question if you guys want. It was tricky...
Edited by DrVirgo on 03/05/07 - 02:40 PM
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| doc_clotaire
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Yeah , Post it please !
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| DrVirgo
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ok, I posted it as a new topic: UW: Tricky Hyperparathyroidism Question.
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| doc_clotaire
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Thanks Buddy !
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| ram3
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The answer is E Surgical exploration of the neck Big Time
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| ts97
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Is Calcium in urine encreased or descreased in this case?
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| doyoudig
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surgery is now the common practise
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| dr in trouble
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yes it is E
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