Scenario 2 – Part 2: The patient underwent parathyroidectomy. The parathyroid adenoma was resected. Histopathological examination revealed well circumscribed lesion, with chief cells arranged within a delicate capillary network. F. Appraise the rationale of medical and surgical parathyroidectomy in this patient. G. How to differentiate between primary, secondary, and tertiary hyperparathyroidism? H. When do […]
Scenario 2 – Part 1: A 38-year-old male patient with CKD stage III A. The patient’s laboratory investigations through the past six months are shown in table 1 Test Jan Feb March Apr May June July S. corrected Calcium 10.52 mg/dL 9.9 mg/dL 9.8 mg/dL 10.2 mg/dL 10.5 mg/dL 11.5 mg/dL 12.1 mg/dL S. Phosphorus […]
Scenario 1 – Part 3: The patient presented again 10 months later with an i-PTH of 1723 pg/mL. He again reported non-adherence to his medications through the past few months. Neck US revealed a large hypoechoic hypervascular mass suggestive of parathyroid adenoma. The patient underwent total parathyroidectomy (PTx) with auto-transplantation to his right forearm. After […]
Scenario 1 – Part 2: The patient’s compliance has been improved after several attempts to convince him with the importance of adherence to his medications. He has been started on cinacalcet, calcitriol, and the dialysate calcium level is maintained at 1.25mmol/L. The patient’s lab one month later showed. Test Value S. Creatinine 3.7 mg/dL S. […]
Scenario 1 – Part 1: A 32-year-old man presents for routine review. He has been on hemodialysis for five years. Hyperphosphatemia had been noticed 9 months previously and the patient had been reviewed by the dieticians at that time. However, the patient refused to follow a phosphate restricted diet and there had been persistent non-compliance […]
