Class Assignment JAMJ Endo Sp 21

Mais informações

BRAIN CANCER

por Angel Kang

PANC-2 -Resectable Disease

por rachel rowling

CC: Chronic Constipation x 5 years

por Pablo Perez

history

por Yipeng Yuan

Mrs. D, 48yo with severe constipation with Calcium level of 11.2

Treatment complications

Chronic Hypocalcemia needing lifelong supplementation of Ca2+ and Vitamin D

Recurrent Laryngeal nerve injury

Hypoparathyroidism

Additional Labs and Results

EKG - shortened QTi, Tall T waves, bradyarrythmias

DEXA - osteoporosis

XR - decreased bone density or normal

PTHrP - increased in malignancy

PTH - increased PTH

Urine: Hypercalciuria, Hyperphosphauria

Serum: Hypercalcemia, Hypophosphatemia, Low 20(OH) Vitamin D

Other Questions to ask the patient

Are you having headaches or feeling like you've had memory changes?

Are you feeling tired or depressed lately?

Any heart palpitations?

Any bone pain, muscle weakness or muscle pain?

Treatment

Surgical Exploration +/- Partial Parathyroidectomy

pt meets criteria for surgery

Endocrinology consult!

PE Findings

Shortened QT intervals

Fatigue

Abdominal pain, nausea and/or vomiting

Muscle weakness and atrophy

Decreased DTR's

Mild bone pain

DDx

Malabsorption Disease

MEN syndrome

Malignancy - Parathyroid adenoma, metastasis

Vitamin D intoxication

Primary Hyperparathyroidism