parathyriod

1. Dr. Abdo shaban
NEPHROLOGY FELLOW SHIP
New Mansoura General Hospital

2.  Male patient named Ramdan Fawzy
 53 years old from Elzagazeg
 Married have 2 offsprings ,works as wall painter , ptn
is smoker
Personal history

3. Complaint
 Generalized bone aches 6 years ago

4.  The patient is known to be ESRD on regular
hemodialysis for 6 years 3 sessions/week
 4 hours/session.
 The condition started 6 years ago with gradual
onset and progressive course of generalized
bone aches ,
 Patient asked medical advice and investigations
were done with revealed elevated serum
calcium , phosphorus and PTH
Present history

5.  Last serum PTH 2300
 Serum :CA:10
 Serum phosphorus:5
Present history

6.  Ptn known HTN 6 years ago
 On alkaprees 10 mg
 Carvid 25 : twice /day
 Extention 300/ once daily
PAST HISTORY

7. Trial of medical treatment
 Patient received one alpha 1mcg I.V per session
for 2 years and calcium capsules but no
improvement
Cinacalcet 30 mg for 2 month twice/day , but no
response

8.  HB:11.4
 WBCS: 5.2
 PLATELETS:190
 INR: 1
 SERUM CA : 10.9 SERUM PHOSPHORUS
: 5 PTH 1900
 SERUM ALBUMEN :4
 SERUM CREATININE:3 SERUM UREA:80
 PH: 7.4 HCO3: 26 PCO2:39
 NA: K:4
Pre-operative Lab

9. Cardiac consultation:
ECG :normal sinus rhythm
Pulse:72beat/min.
ABP:140/80mmHg.
Echo done
 ENT consultation : normal freely mobile vocal
cords
Consultations

10. Decision
Parathyroidectomy :
is the ideal solution in cases of ESRD with tertiary
hyperparathyroidism after failure of oral medical
treatment.