CC: Chronic Constipation x 5 years

Honelako gehiago

NVJHflowers-passang&khotsombath

passang tsering‑k egina

Learing Styles: ELD GCD.

Michael Fitzpatrick‑k egina

Sleep

Sinwoo Kim‑k egina

Transactional Models for behaviour and emotional difficulties

Joerg Bauer‑k egina

Increased Calcium and PO4

Serum PO4

Decreased

Alk Phosphate

Normal to high

Serum PTH

Elevated

Secondary hyperparathyroidism

Primary hyperparathyroidism

Low to normal, consider...

Granulomatous disease: sarcoidosis, TB

Multiple Endocrine Neoplasia (MEN)

Metastatic tumors (hypercalcemia of malignancy)

CC: Chronic Constipation x 5 years

Imaging

Neck US

Possible parathyroid adenoma

DEXA scan

Low bone density

X-ray

EKG

Absent p waves

Short QT interval

Tall and peaked T waves

Colonoscopy

Management

+/- Biphosphonates

Laxatives prn

Calcitonin

Estrogen

Demographics

Female

48 y/o

Labs

Calcium: elevated

Recheck

11.2 mg/dL (elevated)

Renal function

TSH

Normal

FHx

Both parents with HTN

PMHx

Screen for depression

Tobacco use

HTN

Managed with Metoprolol