PTH & USMLE ?

[sevoflurane]

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Quick board question that has been bugging me:

Can anyone tell me what your next course of aciton would be if you have an elevated PTH w/ a Ca+ > 11.5 w/ a decrease P04?
I know that Ca+ levels < 11.5 = 2-3 L of fluid PO +/- bisphosphanate +/- P04. Is the above situation mean surgery of a parathyroid adenoma????? Is that all that is needed to confirm it? No radiology studies to confirm??? What if the patient was totally asymptomatic??? Still surgery?? 😕

Thanx

 

[AlexRusso]

What step of the USMLE was this on??

 

[sevoflurane]

Just studying for step II. I came across a couple of questions with different answers. Cecil's explains work up and management for those under 11.5 that are asymptomatic, but doesn't mention those that are over (and asymptomatic). Just sounds like something I should know before I go in and take it!

 

[AlexRusso]

sorry, wihs I could help but I just finished Step 1. I'm starting with Medicine in 2 weeks so maybe I can help you then. 🙄

 

[sevoflurane]

For those of you interested..... the surgery rockstars from scutwork forum answered me this question...

1) chloride/phosphate ratio is <33 = surgery

2) 2002 NIH Consensus Statement outlines the indications for parathyroidectomy in asymptomatic primary hyperparathyroidism as: Calcium level more than 1mg/dL above normal, 24 hour urine calcium >400mg, renal dysfunction with creatinine clearance <30% of expected, decreased bone mineral density, age <50, or due to compliance/patient issues.

3) Preoperative localization studies have quickly become state of the art (if not yet the "standard of care") & most endocrine surgeons would at least have one (sistamibi sacan) performed to try and avoid the potential morbidity of bilateral neck exploration (ie. bilateral recurrent nerve injury) for what is a single adenoma (when it is due to an adenoma) >90% of the time. pected, decreased bone mineral density, age <50, or due to compliance/patient issues.

 

[Idiopathic]

Actually, Current Medical Diagnosis and Treatment answered that question for you.