A 55-year-old male carpenter presented with a one-year history of generalized bone aches, which was diagnosed as hyperparathyroidism. He had been undergoing hemodialysis for end-stage renal disease (ESRD) for 4 years. Medical treatment with calcium carbonate, alfacalcidol, and cinacalcet was not effective in controlling his hyperparathyroidism. Pre-operative labs showed elevated PTH, calcium, and phosphorus levels. Consultations found no other abnormalities. The decision was made to proceed with parathyroidectomy after failure of oral medical treatment.

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.