05-15-2008, 03:03 PM
50.
A 44-year-old woman is evaluated for fatigue, polyuria, and constipation of 2 years' duration. She has not seen a physician in years because of lack of medical insurance. Laboratory evaluation reveals hypercalcemia, hypophosphatemia, elevated parathyroid hormone level, and increased markers of bone turnover. Subperiosteal bone resorption of the distal phalanges, femoral and spine osteopenia, and osteoporosis in the radius are found. A parathyroid sestamibi scan localizes parathyroid adenoma to the right upper neck; the adenoma is removed by minimally invasive parathyroidectomy. Postoperatively, profound hypocalcemia and hypophosphatemia with tetany develop. The simultaneous parathyroid hormone level is
A 44-year-old woman is evaluated for fatigue, polyuria, and constipation of 2 years' duration. She has not seen a physician in years because of lack of medical insurance. Laboratory evaluation reveals hypercalcemia, hypophosphatemia, elevated parathyroid hormone level, and increased markers of bone turnover. Subperiosteal bone resorption of the distal phalanges, femoral and spine osteopenia, and osteoporosis in the radius are found. A parathyroid sestamibi scan localizes parathyroid adenoma to the right upper neck; the adenoma is removed by minimally invasive parathyroidectomy. Postoperatively, profound hypocalcemia and hypophosphatemia with tetany develop. The simultaneous parathyroid hormone level is