Case 3


So, based on these findings, you diagnose primary hyperparathyroidism. Congratulations!

It was once thought that these patients would be more likely to develop renal disease as a complication of long-term hypercalcemia. Recent studies, however, have shown that progression to renal insufficiency is uncommon.4

In some instances, such as if the ionized calcium and PTH concentrations are in the grey zone or the patient will be undergoing parathyroidectomy, an ultrasonographic examination of the neck may be indicated to look for an enlarged gland. This procedure should be performed by someone with experience in looking for the parathyroid glands. And remember that even if the glands are normal on the ultrasonographic examination, it does not rule out hyperparathyroidism.



What are the options for treating a patient with primary hyperparathyroidism? (There is more than one correct answer.)

a) Oral prednisone to increase calcium excretion into the urine

b) Parathyroidectomy

c) Treatment with bisphosphonates

d) Ethanol ablation

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