Kategorien: Alle - bone - depression - hypertension

von Pablo Perez Vor 3 Jahren

268

CC: Chronic Constipation x 5 years

The patient, a 48-year-old female, presents with chronic constipation persisting for five years and a history of hypertension managed with Metoprolol. Her medical history includes tobacco use and a need for depression screening.

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