dr.mohmed elsharkawy

1. Dr. Mohamed Elsharkawy
Egyptian Fellowship of
Nephrology
New Mansoura General Hospital

2.  A 55-year old male patient named Diaa Eldin
Mahmoud Awad from Damietta ,married , has four
offspring , carpenter , no special habits of medical
importance.
Personal history

3. Complaint
 Generalized bone aches specially both
lower limbs year ago.

4.  The condition started a year ago in gradual onset
, progressive course of generalized bone aches
specially in both lower limbs.
 Patient seeked medical advice and investigations
were done which diagnosed as (
hyperparathyroidism).
Present history

5. Present history
 Patient received calcium carbonate and
alfacalcidol 1mcg caps for 4 years then started
alfacalcidol 1mcg IV 2 weeks ago , but no
improvement.
 Cinacalcet 30 mg once /day for 2 months then
twice/day , but no response.

6. Lab
PTHpo4Cadate
20057.19.88/2018
25007.89.51/2019
>20006.99.610/2019

7.  ESRD on regular HD through AVF 4 years ago.
Past history

8.  HB: 12.5
 WBCS: 8
 PLATELETS: 210
 INR: 1.05
 SERUM CA : 8.8 SERUM PHOSPHORUS
: 7.8
 PTH >2000
 SERUM ALBUMEN : 4.1
 SERUM CREATININE: 13.7 SERUM UREA:
183
 PH: 7.42 HCO3: 20.3 PCO2: 38
 Na: 138 K: 5.4
Pre-operative Lab

9. Cardiac consultation:
ECG: normal.
Pulse:72beat/min.
ABP:120/80mmHg.
No other abnormality detected.
 ENT consultation : normal freely
mobile vocal cords.
Consultations

10. Decision
Parathyroidectomy after failure of oral medical
treatment.