によって Pablo Perez 4年前.
417
CC: Chronic Constipation x 5 years
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