カテゴリー 全て - fatigue - surgery

によって Jasmine Juliette 3年前.

241

Class Assignment JAMJ Endo Sp 21

A 48-year-old woman presents with severe constipation and multiple other health concerns, including hypercalcemia, osteoporosis, and muscle weakness. Elevated parathyroid hormone levels and abnormal EKG findings, such as shortened QT intervals and bradyarrhythmias, indicate possible underlying issues.

Class Assignment JAMJ Endo Sp 21

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