Scenario 2 – Part 2: Sevelamer was discontinued and the patient was started on calcium, phosphate, and Vit D supplementations for three months. However, the patient’s clinical symptoms did not improve and was seen limping throughout the last two weeks. A bone biopsy was done considering the worsening of his condition. His lab showed the […]
Scenario 2 – Part 1: A 19-year-old male on regular hemodialysis for three years, presents for pre-transplant assessment. The patient reported recurrent attacks of severe bone and joint aches. The patient was taking sevelamer three times per day with meals and alfacalcidol 0.25 mcg three times a week. Review of the patient’s laboratory investigations are […]
Scenario 1 – Part 3: The patient was initially treated with cinacalcet, followed by parenteral bisphosphonates for three months with good initial effect on serum calcium levels, however, the PTH remained elevated (PTH 597 pg/mL). Notably, serum calcium started to increase again despite bisphosphonates. E. Suggest a management plan for this patient. F. Cinacalcet […]
Scenario 1 – Part 2: Hyperfunction of the remaining parathyroid glands was thought and total parathyroidectomy was suggested. However, an attempt to perform total parathyroidectomy failed and the patient’s hypercalcemia persisted. C. Discuss the pros and cons of different surgical techniques used for parathyroidectomy. D. Appraise the role of calcitonin and alendronate in this […]
Scenario 1 – Part 1: A 43-year-old male patient who has been on HD for 10 years, underwent parathyroidectomy 18 months ago due to severe hyperparathyroidism. The histopathology confirmed parathyroid adenoma. For one year after parathyroidectomy, the patient had normal PTH and calcium levels. However, the patient showed abnormally high serum calcium and PTH levels […]
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