A 58-year-old male with a history of end stage renal disease and hemodialysis for 15 years presented with generalized bone aches and persistent itching for one year. He was diagnosed with hyperparathyroidism. Medical treatment with calcium carbonate, cinacalcet, and sevelamer was unsuccessful in controlling his symptoms or lowering his elevated parathyroid hormone, calcium, and phosphate levels. Pre-operative evaluations found no abnormalities. The decision was made to proceed with parathyroidectomy after medical treatment failed to adequately manage his hyperparathyroidism.

1. Nephrology specialist
New Mansoura General Hospital

2. A 58year-old male patient from
Zagazig , driver, married , has
four offspring , no special habits
of medical importance .
Personal history

3. Complaint
Generalized bone aches , persistent itching 1
year ago.

4.  The condition started 6 months ago with gradual
onset , progressive course of generalized bone
aches , persistent itching.
 Patient seeked medical advice and investigations
were done which diagnosed
as(hyperparathyroidism) .
Present history

5. Trial of medical treatment
 Patient received calcium carbonate
 Cinacalcet 60 mg /day for 2 monthes but could
not tolerate its side effects(gastritis –vomiting).
 Phosphate binder as sevelamer , but no
response .
Present history

6. labs
PTHs.phs.cadate
2000
pglml
7 mgldl9 mgldl4/4/2019
2700
pglml
7.1 mgldl9.6 mgldl21/7/2019
3300
pglml
5.7 mgldl9.1 mgldl17/10/20119

7.  End stage renal disease on regular
hemodialysis 15 year ago .
Past history

8.  CBC ABG
Tlc :7.10 PH 7.37
Hgb: 10.3 PCO2 41
Plt :146000 Hco3 23
Renal profile and electrolytes:
S creatinine :13.3 mg/dl Urea :118
mg/dl
Na : 137 mmol/l K : 5.2
mmol/l
Alb :4.2 Ca :9.1
Po4 :5.7
INR: 1.02 vitD total
Pre-operative INV.

9. Cardiac consultation:
ECG ==> normal.
ABP ==> 140/80mmHg.
Pulse ==> 72beat/min.
No other abnormality was detected.
ENT consultation : normal freely mobile vocal
cords .
Consultations

10. Decision
Parathyroidectomy after failure of medical
treatment.