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Old 07-28-2012
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Question Hypercalcemia and management

A 41-year-old man underwent a successful living related kidney transplantation 1 year previously with good results. Preoperatively, he was noted to have an elevated calcium level; posttransplantation, he continues to have elevated calcium levels and associated symptoms. Which of the following is the most appropriate next step in management?

a. 99mTc sestamibi scanning
b. Ultrasound of the neck
c. CT scan of the neck and mediastinum
d. Total parathyroidectomy with autotransplantation of a portion of a gland into
the forearm
e. Measurement of urinary calcium levels
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Old 07-28-2012
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I think its e
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Old 07-28-2012
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Quote:
Originally Posted by steroids View Post
I think its e
Reasons?...First what is the diagnosis...then support your answer with reasons...
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Old 07-28-2012
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i think e too.
dx? well, RF ->hypercalcemia**->transplant
**due to autonomous high PTH [tertiary hyperPTH]

prior to removal, its must to rule out familial hypocalciuric hypercalcemia...what i read was in any patient going PTHectomy need this test .after that, D would be correct. sestamibi scan and anatomical location tests are not needed now.

this what strikes my mind!
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Old 07-28-2012
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d. Total parathyroidectomy with autotransplantation of a portion of a gland into the forearm

Patient has symptomatic Hypercalcemia due to secondary hyperparathyroidism which has continued despite renal transplantation.
In Renal failure secondary hyperparathyroidism (due to parathyroid hyperplasia) is caused by uremia and in some patients it continues even after renal transplantation.

calcimimetic drug like cinacalcet are the latest trend but it has not been approved for this condition.

Last edited by Novobiocin; 07-28-2012 at 03:28 PM.
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Old 07-28-2012
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D..is correct!!!..tertiary hyperparathyroidism is the diagnosis
Indications for pthectomy

1. Symptomatic...vignette says assoc symptoms
OR if asymptomatic then look for....
2. Urinary calcium greater than 400mg in 24 hrs
3. Ca greater than 1 mg/dl above upper limit
4. Age less than 50
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Tertiary Hyperparathyroidism

Quote:
Tertiary hyperparathyroidism is a state of excessive secretion of parathyroid hormone after longstanding secondary hyperparathyroidism and resulting in hypercalcemia. Some authorities reserve the term for secondary hyperparathyroidism that persists after successful renal transplantation.
Clinical Impact of Hypercalcemia in Kidney Transplant
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Electrolytes-, Endocrinology-, Internal-Medicine-, Step-2-Questions

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