Mrs. D, 48yo with severe constipation with Calcium level of 11.2
DDx
Primary Hyperparathyroidism
Vitamin D intoxication
Malignancy - Parathyroid adenoma, metastasis
MEN syndrome
Malabsorption Disease
PE Findings
Mild bone pain
Decreased DTR's
Muscle weakness and atrophy
Abdominal pain, nausea and/or vomiting
Fatigue
Shortened QT intervals
Treatment
Endocrinology consult!
Surgical Exploration +/- Partial Parathyroidectomy
pt meets criteria for surgery
Other Questions to ask the patient
Any bone pain, muscle weakness or muscle pain?
Any heart palpitations?
Are you feeling tired or depressed lately?
Are you having headaches or feeling
like you've had memory changes?
Additional Labs and Results
Serum: Hypercalcemia, Hypophosphatemia, Low 20(OH) Vitamin D
Urine: Hypercalciuria, Hyperphosphauria
PTH - increased PTH
PTHrP - increased in malignancy
XR - decreased bone density or normal
DEXA - osteoporosis
EKG - shortened QTi, Tall T waves, bradyarrythmias
Treatment complications
Hypoparathyroidism
Recurrent Laryngeal nerve injury
Chronic Hypocalcemia needing lifelong
supplementation of Ca2+ and Vitamin D