N2BATE
Forum Newbie
Topics: 3
Posts: 11
|
Quick question that has been bugging me.
Can anyone tell me what your next course of action would be if you have an elevated PTH, a Ca+ > 11.5 w/ a decrease P04 ?
(I think that Ca+ levels < 11.5 + asymptomatic patient = 2-3 L of fluid PO +/- bisphosphanate +/- P04)
Is the above situation mean surgery of a parathyroid adenoma????? Is that all that is needed to secure the diagnosis? No radiology studies to confirm??? What if the patient was totally asymptomatic??? Still surgery?? What is a sistamibi scan??
Thanks 8)
___________________
I put my hand in the shadow,
pull the pieces from the sand
Try, attempt to reasemble,
and find out who I might have been.
|
| N2BATE
Forum Newbie
Topics: 3
Posts: 11
|
I found the answers I was looking for... for those of you interested, here it is....
1) chloride/phosphate ratio is <33 = surgery... no questions
2) 2002 NIH Consensus Statement outlines the indications for parathyroidectomy in asymptomatic primary hyperparathyroidism as: Calcium level more than 1mg/dL above normal, 24 hour urine calcium >400mg, renal dysfunction with creatinine clearance <30% of expected, decreased bone mineral density, age <50, or due to compliance/patient issues.
3) Preoperative localization studies have quickly become state of the art (if not yet the "standard of care") & most endocrine surgeons would at least have one performed (sistamibi scan- nuclear medicine study that localizes PTH adenoma/hyperplasia) to try and avoid the potential morbidity of bilateral neck exploration (ie. bilateral recurrent nerve injury) for what is a single adenoma (when it is due to an adenoma) >90% of the time.- if asked on the test.... I would probably not pick a sistamibi scan because it is not absolutely needed to go ahead and chop! 8)
___________________
I put my hand in the shadow,
pull the pieces from the sand
Try, attempt to reasemble,
and find out who I might have been.
|
| drnamita
Forum Newbie
Topics: 0
Posts: 3
|
Thank you I came to know more about the Sistamibi scan. :P
|
| daira
Forum Senior
Topics: 29
Posts: 138
|
so is the previous limit of 11.5 outdated now ? Meaning we should answer surgery if Ca is 1mg higher than expected value and pt has signs and symptoms ? No medical treatment options in that case?
___________________
Roz barhta hoon jahan se aagey
lout kar phir waheen aa jata hoon
baaraha tor chuka hoon jinko
phir unhin dewaroon se takrata hoon...
|
|
| |
| | | | |
