Southern Derbyshire Shared Care Pathology Guidelines. Primary Hyperparathyroidism
|
|
- Aldous Henry Bryan
- 6 years ago
- Views:
Transcription
1 Southern Derbyshire Shared Care Pathology Guidelines Primary Hyperparathyroidism Please use this Guideline in Conjunction with the Hypercalcaemia Guideline Definition Driven by hyperfunction of one or more of the parathyroid glands, the hallmark of primary hyperparathyroidism is a circulating level of PTH which is inappropriately high for the level of calcium. Most patients are hypercalcaemic but the condition is gradually progressive and hypercalcaemia can be intermittent initially. Concurrent Vitamin D deficiency causes higher levels of PTH and can occasionally lead to misleadingly normal calcium levels. Onset of primary hyperparathyroidism most commonly occurs between years and is more common in elderly women. Aetiology Over 80% of primary hyperparathyroidism cases are caused by a single parathyroid adenoma of the parathyroid gland. Other causes include: Multiple adenomas (5%) Diffuse hyperplasia (12%) - common in lithium treated patients Carcinoma (2%) Ectopic PTH-secreting tumour (very rare) In younger patients (<40y) with primary hyperparathyroidism please consider a familial cause. Multiple adenomas or hyperplasia also suggests possible genetic aetiology. For example, co-existence of hypercalcaemia with hypertension and neurofibroma is suggestive of multiple endocrine neoplasia type 2. Clinical effects of Hyperparathyroidism The clinical features of hyperparathyroidism tend to be non-specific and are related to the aetiology of the hyperparathyroidism and the level of serum calcium. Most cases are now picked up incidentally during blood investigations- and many patients are asymptomatic. Authorised by Julia Forsyth Page 1 of 5
2 Features may include: Polyuria, thirst, weakness, vomiting Fracture risk: o a study undertaken in 2000 in Denmark looked at 674 patients with primary hyperparathyroidism, showing that those with primary hyperparathyroidism were at increased risk of vertebral, distal lower limb and forearm fractures before surgery, but not after, compared with a control group (relative risk, RR 1.8 before surgery and 1.0 after surgery) Renal calculi in 10-15% of patients Bone resorption leading to bone pain or pathological fracture: o the main affected areas are where bone turnover is most active such as in the vertebrae, phalanges, ends of long bones and the skull o In advanced disease bone resorption leads to formation of bone cysts or brown tumours, with deformities leading to fracture or bending of bones and/or a classical pepper-pot skull seen on plain XR. o These changes are now rare as cases tend to be diagnosed at an earlier stage Other features of metastatic calcification may be present such as nephrocalcinosis, and corneal calcification Rarely, primary hyperparathyroidism may present as acute pancreatitis Investigations and Initial Diagnosis For the initial diagnosis of Primary Hyperparathyroidism please refer to the Hypercalcaemia Guideline. For patients presenting with hypercalcaemia without a known cause, dependent upon clinical details provided the laboratory measures: PTH Alkaline Phosphatase Phosphate U & E Be aware that primary hyperparathyroidism may coexist with cancer, resulting in PTH levels that are normal or elevated despite cancer being present- relevant clues to this occurrence would be rapidly progressive hypercalcaemia and/or symptoms of the relevant malignancy Authorised by Julia Forsyth Page 2 of 5
3 When to Refer It is recommended that after the initial diagnosis of Primary Hyperparathyroidism has been made the patient is referred to a Consultant Endocrinologist for: Confirmation of diagnosis Excluding other possible co-existing causes of hypercalcaemia Assessment of Vitamin D status o Advice on Vitamin D supplements if required o Advice on dietary calcium intake If appropriate, treatment with a bisphosphonate or alternatives to protect bone from excessive resorption Assessment of Urine Calcium Excretion Index o Low levels indicate Familial Hypocalciuric Hypercalcaemia. o Falsely low calcium excretion index is seen in Vitamin D deficiency and with thiazide diuretics Assessing the need for parathyroidectomy and surgical referral. Potential indications for parathyroidectomy include: o Symptomatic disease- mild hypercalcaemia does not cause significant symptoms (ie the symptoms are non-specific and are often due to other pathologies) o People younger than 50 years of age o Kidney stones o Serum calcium concentration that is 0.25 mmol/l or more above the upper end of the reference range o egfr < 60 ml/min o Reduced bone mineral density at lumbar spine, femoral neck, total hip, or distal radius Ultrasound of the parathyroids and Nuclear Medicine Sestamibi scan are scans used for surgical planning. They are specialist investigations and are not a way of diagnosing primary hyperparathyroidism. All younger patients (<40y) should be referred to a Consultant Endocrinologist to rule out familial causes. When doing so it is especially advised that you ask the patient to provide a random urine sample (plain plastic universal container) for a urine calcium excretion index for the differential diagnosis of FHH. Young patients also have the most to gain from surgical treatment for primary hyperparathyroidism. In some cases it would be appropriate to ask advice from the Endocrinology team rather than clinical review (for example in patients where attendance to clinic is a challenge or where extent of hypercalcaemia mild). Authorised by Julia Forsyth Page 3 of 5
4 In order for this first outpatient appointment to readily identify the patient s needs and treatment please measure the following: o U&E s o Bone Profile (Ca, Phos, ALP, Alb) o PTH o Serum 25-Hydroxy Vitamin D Consider requesting a DEXA scan prior to the outpatient appointment if this has not been done in the last 3 years and the patient does not have known osteoporosis. Once an initial assessment has been undertaken, monitoring of people with asymptomatic primary hyperparathyroidism who have no indications for parathyroidectomy or who decline parathyroidectomy may be done in primary care. In Primary Care Monitor: o Serum calcium and renal function every 12 months o Blood pressure every 6 months o Bone mineral density (at lumbar spine, femoral neck, total hip, and distal radius) every 3 years (or according to instructions at the time of discharge from Endocrine clinic) Refer the person back to the endocrinologist if: o Individual criteria may be set at the time of discharge from Endocrinology clinic - check the relevant letter Typical criteria for re-referral include: o Significant symptoms of hypercalcaemia develop o Adjusted calcium persistently >2.85 mmol/l - as this is an indication to consider surgical management o Adjusted serum calcium is > 3.0 mmol/l - even if surgery is not planned this calls for a review of all treatment options and follow-up plans o At any site on bone mineral density measurement, the T-score is 2.5 or less (for peri-menopausal or postmenopausal women, and men 50 years of age or older) or the Z-score is 2.5 or less (for premenopausal women and men younger than 50 years of age)- although in many patients this is due to other factors and may not always indicate a need for parathyroidectomy o The egfr falls by >10 ml/min since first diagnosis (dependent on the rapidity of the fall in egfr, and for all patients where the egfr fall less than 30. Renal referral is more likely to be indicated in the first instance). Authorised by Julia Forsyth Page 4 of 5
5 Contacts Duty Biochemist Endocrinology Advice (8am to 7pm, Mon Fri) (9am 5pm, Mon Fri) Authors: Dr Penny Blackwell, Dr Rustam Rea January 2012 Reviewed by: Date: Expiry date: Dr P Blackwell, Dr R Stanworth, Mrs H Seddon May st May 2016 Dr P Blackwell, Dr R Stanworth, Mrs H Seddon Jan st Jan 2019 Authorised by Julia Forsyth Page 5 of 5
Definition Elevated Adjusted Calcium > 2.6 mmol/l (adjusted for albumin), taken without using a cuff.
Authoriser: Fiona Davidson Page 1 of 5 Hypercalcaemia Definition Elevated Adjusted Calcium > 2.6 mmol/l (adjusted for albumin), taken without using a cuff. Mild (usually no symptoms) 2.6 3.0 mmol/l Moderate
More informationDefinition Elevated Adjusted Calcium > 2.6 mmol/l (adjusted for albumin), taken without using a cuff.
Hypercalcaemia Definition Elevated Adjusted Calcium > 2.6 mmol/l (adjusted for albumin), taken without using a cuff. Mild (usually no symptoms) 2.6 3.0 mmol/l Moderate (start to develop symptoms) 3.0 3.4
More informationApproach to a patient with hypercalcemia
Approach to a patient with hypercalcemia Ana-Maria Chindris, MD Division of Endocrinology Mayo Clinic Florida 2013 MFMER slide-1 Background Hypercalcemia is a problem frequently encountered in clinical
More informationSouthern Derbyshire Shared Care Pathology Guidelines. Hypocalcaemia in Adults
Southern Derbyshire Shared Care Pathology Guidelines Hypocalcaemia in Adults Purpose of Guideline The investigation and management of patients with newly diagnosed hypocalcaemia Definition Adjusted (corrected)
More informationHYPERPARATHYROIDIS M FAISAL GHANI SIDDIQUI MBBS; FCPS; PGDIP-BIOMEDICAL ETHICS; MCPS-HPE
HYPERPARATHYROIDIS M FAISAL GHANI SIDDIQUI MBBS; FCPS; PGDIP-BIOMEDICAL ETHICS; MCPS-HPE PROFESSOR OF SURGERY J I N N A H S I N D H M E D I C A L U N I V E R S I T Y PREAMBLE Anatomy & physiology of the
More informationPRIMARY HYPERPARATHYROIDISM PRIMARY HYPERPARATHYROIDISM. Hyperparathyroidism Etiology. Common Complex Insidious Chronic Global Only cure is surgery
ENDOCRINE DISORDER PRIMARY HYPERPARATHYROIDISM Roseann P. Velez, DNP, FNP Francis J. Velez, MD, FACS Common Complex Insidious Chronic Global Only cure is surgery HYPERPARATHYROIDISM PARATHRYOID GLANDS
More informationHyperparathyroidism: Operative Considerations. Financial Disclosures: None. Hyperparathyroidism. Hyperparathyroidism 11/10/2012
Hyperparathyroidism: Operative Considerations Financial Disclosures: None Steven J Wang, MD FACS Associate Professor Dept of Otolaryngology-Head and Neck Surgery University of California, San Francisco
More informationCase study Group 2 presentation
Case study Group 2 presentation Patient profile HN 3095-57 Female 60 years old Hometown : Sa Kaeo province Occupation : farmer No drug and food allergy Chief complain Left neck mass 10 years PTA that gradually
More informationHyperparathyroidism (primary): diagnosis, assessment and initial management
National Institute for Health and Care Excellence. Hyperparathyroidism (primary): diagnosis, assessment and initial management NICE guideline . October 2018 This guideline was developed by the
More informationPrimary Hyperparathyroidism
Primary Hyperparathyroidism Copyright Copyright 2019 2019 American American Associa7on Associa7on of Clinical of Clinical Endocrinologists Endocrinologists 1 Primary Hyperparathyroidism In primary hyperparathyroidism
More informationCalcium Nephrolithiasis and Bone Health. Noah S. Schenkman, MD
Calcium Nephrolithiasis and Bone Health Noah S. Schenkman, MD Associate Professor of Urology and Residency Program Director, University of Virginia Health System; Charlottesville, Virginia Objectives:
More informationhypercalcemia of malignancy hyperparathyroidism PHPT the most common cause of hypercalcemia in the outpatient setting the second most common cause
hyperparathyroidism A 68-year-old woman with documented osteoporosis has blood tests showing elevated serum calcium and parathyroid hormone (PTH) levels: 11.2 mg/dl (8.8 10.1 mg/dl) and 88 pg/ml (10-60),
More informationCases in Endocrinology
Bones, Moans and Groans Diagnosing and Treating Primary Hyperparathyroidism By M. Usman Chaudhry, MD Table 1 Laboratory parameters Her bone density had osteopenic T-Scores of -2.3 at lumbar spine, and
More informationPRIMARY HYPERPARATHYROIDISM
PRIMARY HYPERPARATHYROIDISM HYPERPARATHYROIDISM Inappropriate excess secretion of Parathyroid Hormone in Primary Hyperparathyroidism Appropriate Hypersecretion in Secondary Hyperparathyroidism PTH and
More informationSince the advent of multichannel serum chemistry
ONLINE EXCLUSIVE Padmaja Sanapureddy, MD; Vishnu Vardhan Garla, MD; Mallikarjuna Reddy Pabbidi, DVM, PhD Department of Primary Care and Medicine, G.V. (Sonny) Montgomery VA Medical Center, Jackson, Miss
More informationHYPERCALCEMIA. Babak Tamizi Far MD. Assistant professor of internal medicine Al-zahra hospital, Isfahan university of medical sciences
HYPERCALCEMIA Babak Tamizi Far MD. Assistant professor of internal medicine Al-zahra hospital, Isfahan university of medical sciences ESSENTIALS OF DIAGNOSIS Serum calcium level > 10.5 mg/dl Serum ionized
More informationHyperparathyroidism. When to Suspect, How to Diagnose, When and How to Intervene. Johanna A. Pallotta, MD, FACP, FACE
Hyperparathyroidism When to Suspect, How to Diagnose, When and How to Intervene Johanna A. Pallotta, MD, FACP, FACE Potential conflicts of interest: None Johanna A. Pallotta, MD Outline Definition of hyperparathyroidism
More informationMagnesium Homeostasis
ECTS PhD Training Course, Rome 3 rd September 2008 Disorders of Calcium, Phosphate h and Magnesium Homeostasis Richard Eastell Professor of Bone Metabolism Academic Unit of Bone Metabolism University of
More informationSouthern Derbyshire Shared Care Pathology Guidelines. Secondary Hypertension
Southern Derbyshire Shared Care Pathology Guidelines Secondary Hypertension Purpose of Guideline This guideline covers the investigation and referral criteria of patients with suspected secondary causes
More information"Asymptomatic" Hyperparathyroidism: Reasons for Parathyroidectomy
"Asymptomatic" Hyperparathyroidism: Reasons for Parathyroidectomy Rebecca S. Sippel, M.D. Assistant Professor Department of Surgery Section of Endocrine Surgery University of Wisconsin Primary Hyperparathyroidism
More informationWomen s Health in General Practice Symposium 2015 Thyroid & Parathyroid Cases
Women s Health in General Practice Symposium 2015 Thyroid & Parathyroid Cases Bill Fleming Epworth Freemasons Hospital 1 Common Endocrine Presentations anatomical problems thyroid nodule / goitre embryological
More informationCase 2: 30 yr-old woman with 7 yr history of recurrent kidney stones
Case 2: 30 yr-old woman with 7 yr history of recurrent kidney stones Giuliano Mariani Regional Center of Nuclear Medicine, University of Pisa Medical School, Pisa (Italy) 30 yr-old woman with 7 yr history
More informationSouthern Derbyshire Shared Care Pathology Guidelines. Hyperkalaemia
Southern Derbyshire Shared Care Pathology Guidelines Hyperkalaemia Purpose of Guideline Dealing with adult patients with Hyperkalaemia in the community Definition Serum potassium normal range is 3.5 5.3
More informationInternational Journal of Biological & Medical Research. An Uncommon Case of Persistent Hypercalcaemia following Parathyroid Surgery
Int J Biol Med Res.2015;6(4):5336-5340 Int J Biol Med Res www.biomedscidirect.com Volume 6, Issue 2, April 2015 Contents lists available at BioMedSciDirect Publications International Journal of Biological
More informationThe parathyroid glands participate in the regulation
41 HERNAN I. VARGAS STANLEY R. KLEIN The parathyroid glands participate in the regulation of calcium metabolism. Disorders of the parathyroid gland are most commonly a result of hyperfunction and rarely
More informationPRIMARY HYPERPARATHYROIDISM WITH RICKETS. KRITHIKA.P Dr.L.N.Padmasani Unit 1 Sri Ramachandra Medical College
PRIMARY HYPERPARATHYROIDISM WITH RICKETS KRITHIKA.P Dr.L.N.Padmasani Unit 1 Sri Ramachandra Medical College Presenting Complaints v 17 year old developmentally normal adolescent boy, first of a twin pregnancy,
More informationSouthern Derbyshire Shared Care Pathology Guidelines. Hyperthyroidism
Southern Derbyshire Shared Care Pathology Guidelines Hyperthyroidism Purpose of Guideline The management and referral criteria of patients with newly diagnosed hyperthyroidism. Background Hyperthyroidism
More informationCKD: Bone Mineral Metabolism. Peter Birks, Nephrology Fellow
CKD: Bone Mineral Metabolism Peter Birks, Nephrology Fellow CKD - KDIGO Definition and Classification of CKD CKD: abnormalities of kidney structure/function for > 3 months with health implications 1 marker
More informationSymptom management: Hypercalcemia
Symptom management: Hypercalcemia Dr Claire Higham 10.11.16 NLCFN National Conference 2016 Consultant Endocrinologist The Christie Hospital Manchester, UK Hypercalcemia of malignancy 2-30% of patients
More informationHypercalcemia & Parathyroid Disorders. W. Reid Litchfield, MD, FACE, ECNU Desert Endocrinology
Hypercalcemia & Parathyroid Disorders W. Reid Litchfield, MD, FACE, ECNU Desert Endocrinology Objectives Review diagnostic workup for hypercalcemia Review management of primary hyperparathyroidism Review
More informationParathyroid Disease Scenarios for the Practicing Clinician. Vijaya Chockalingam MD Faculty Endocrinologist Banner University Medical Center- Phoenix
Parathyroid Disease Scenarios for the Practicing Clinician Vijaya Chockalingam MD Faculty Endocrinologist Banner University Medical Center- Phoenix Clinical Scenario-1 73 year man (BK) with hypercalcemia
More informationHYPERCALCAEMIA 101 FOR THE INTERNIST
HYPERCALCAEMIA 101 FOR THE INTERNIST Dr Chionh Siok Bee Dept of Medicine, National University Hospital siok_bee_chionh@nuhs.edu.sg Medicine Review Course 18/09/2011 Outline of Talk Definition of hypercalcaemia
More informationHypercalcemia. Hypercalcemia: When to Worry, When to Treat! Mineral Metabolism : A Short Course
Hypercalcemia: When to Worry, When to Treat! Michael A. Levine has no financial relationships to disclose or Conflicts of Interest to resolve. Michael A. Levine, M.D. This presentation will not involve
More informationSouthern Derbyshire Shared Care Pathology Guidelines. Hyponatraemia in Adults
Southern Derbyshire Shared Care Pathology Guidelines Hyponatraemia in Adults Purpose of Guideline The investigation and management of adult patients with newly diagnosed hyponatraemia. Hyponatraemia can
More informationClinical Approach to Hypercalcemia For the Primary Care Provider
Clinical Approach to Hypercalcemia For the Primary Care Provider Christina Maser, MD FACS UCSF Fresno Department of Surgery, Endocrine Surgery 2/2/19 Objectives Recognition of pitfalls of diagnosis of
More informationCalcium and Parathyroid Disorders
Calcium and Parathyroid Disorders Hussain Mahmud, MD Clinical Assistant Professor of Medicine Division of Endocrinology, Diabetes, and Metabolism University of Pittsburgh Butler Memorial Hospital November
More informationHypercalcemia may be detected incidentally. Practice CMAJ. Primary hyperparathyroidism. Primer. Key points. The case. What causes hypercalcemia?
CMAJ Practice Primer Primary hyperparathyroidism Hafsah Al-Azem HBSc, Aliya Khan MD The case A 17-year-old man presented at the clinic with thirst, lethargy and fatigue that had been ongoing for several
More informationGuideline for the investigation and management of osteoporosis. for hospitals and General Practice
Guideline for the investigation and management of osteoporosis for hospitals and General Practice Background Low bone density is an important risk factor for fracture. The aim of assessing bone density
More informationWhen the level of calcium in the blood falls too low, the parathyroid glands secrete just enough PTH to restore the blood calcium level.
Hyperparathyroidism Primary hyperparathyroidism is a disorder of the parathyroid glands, also called parathyroids. Primary means this disorder originates in the parathyroids: One or more enlarged, overactive
More informationMen and Osteoporosis So you think that it can t happen to you
Men and Osteoporosis So you think that it can t happen to you Jonathan D. Adachi MD, FRCPC Alliance for Better Bone Health Chair in Rheumatology Professor, Department of Medicine Michael G. DeGroote School
More informationPersistent post transplant hyperparathyroidism. Shiva Seyrafian IUMS-97/10/18-8/1/2019
Persistent post transplant hyperparathyroidism Shiva Seyrafian IUMS-97/10/18-8/1/2019 normal weight =18-160 mg In HPT= 500-1000 mg 2 Epidemiology Mild 2 nd hyperparathyroidism (HPT) resolve after renal
More informationAromatase Inhibitors & Osteoporosis
Aromatase Inhibitors & Osteoporosis Miss Sarah Horn Consultant Oncoplastic Breast Surgeon April 2018 Aims Role of Aromatase Inhibitors (AI) in breast cancer treatment AI s effects on bone health Bone health
More informationPrimary hyperparathyroidism A clinical study
Med. J. Malaysia Vol. 43 No. 3 September 1988 Primary hyperparathyroidism A clinical study K. L. Goh, MBBS(Mal), MRCP(UK) Lecturer in Medicine F. Wang, MBBS(Sing), FRCP(Edin), FRACP, FACP Professor ofmedicine
More informationEndocrine Regulation of Calcium and Phosphate Metabolism
Endocrine Regulation of Calcium and Phosphate Metabolism Huiping Wang ( 王会平 ), PhD Department of Physiology Rm C516, Block C, Research Building, School of Medicine Tel: 88208252 Email: wanghuiping@zju.edu.cn
More informationClinical biochemistry of calcium and vitamin D
Clinical biochemistry of calcium and vitamin D Dr Andrew Day Consultant in Clinical Biochemistry and Metabolic Medicine University Hospitals Bristol NHS Trust e-mail: andrew.day@uhbristol.nhs.uk A 48-year
More informationOverview. Bone Biology Osteoporosis Osteomalacia Paget s Disease Cases. People Centred Positive Compassion Excellence
Overview Osteoporosis and Metabolic Bone Disease Dr Chandini Rao Consultant Rheumatologist Bone Biology Osteoporosis Osteomalacia Paget s Disease Cases Bone Biology Osteoporosis Increased bone remodelling
More informationRadiographic Appearance Of Primary Hyperparathyroidism With Atypical Parathyroid Adenoma
ISPUB.COM The Internet Journal of Internal Medicine Volume 6 Number 2 Radiographic Appearance Of Primary Hyperparathyroidism With Atypical Parathyroid Adenoma P George, N Philip, B Pawar Citation P George,
More informationSouthern Derbyshire Shared Care Pathology Guidelines. Hypothyroidism
Southern Derbyshire Shared Care Pathology Guidelines Hypothyroidism Purpose of Guideline The management and referral criteria of patients with newly diagnosed hypothyroidism in adults. Background Hypothyroidism
More informationHypercalcemia. Brian Rose, M.D. Bozeman Health June 6, 2018
Hypercalcemia Brian Rose, M.D. Bozeman Health June 6, 2018 Hypercalcemia Diagnosis PTH Mediated Primary Hyperparathyroidism Lithium Familial Hypocalciuric Hypercalcemia Non PTH mediated Malignancy Humoral
More informationOsteoporosis/Fracture Prevention
Osteoporosis/Fracture Prevention NATIONAL GUIDELINE SUMMARY This guideline was developed using an evidence-based methodology by the KP National Osteoporosis/Fracture Prevention Guideline Development Team
More informationPrimary hyperparathyroidism
How to Treat PULL-OUT SECTION Complete How to Treat quizzes online /cpd to earn CPD or PDP points. INSIDE Pathophysiology Clinical features Investigations Management Prognosis Special cases Case study
More informationBARTS ENDOCRINE E-PROTOCOLS CALCIUM DISORDERS AND BONE
HYPERCALCAEMIA CALCIUM DISORDERS Clinical features to record Symptoms: Thirst, polyuria, nocturia, tiredness, poor concentration, depression, constipation, episodes of renal colic/calculi, hypertension,
More informationChallenges in the Management of Primary HPTH. Zaher Ajam, MD Ghada El-Hajj Fuleihan, MD, MPH
Challenges in the Management of Primary HPTH Zaher Ajam, MD Ghada El-Hajj Fuleihan, MD, MPH Case Presentation 1 This a case of a 41-year-old gentleman who is referred to Endocrinology clinic for low BMD,
More informationAwaisheh. Mousa Al-Abbadi. Abdullah Alaraj. 1 Page
f #3 Awaisheh Abdullah Alaraj Mousa Al-Abbadi 1 Page *This sheet was written from Section 1 s lecture, in the first 10 mins the Dr. repeated all the previous material relating to osteoporosis from the
More informationPotential conflicts of interest: None
Hyperparathyroidism When to Suspect, How to Diagnose, When and How to Intervene November 6, 2013 Johanna A. Pallotta, MD, FACP, FACE Potential conflicts of interest: None Johanna A. Pallotta, MD Outline
More informationClinician s Guide to Prevention and Treatment of Osteoporosis
Clinician s Guide to Prevention and Treatment of Osteoporosis Published: 15 August 2014 committee of the National Osteoporosis Foundation (NOF) Tipawan khiemsontia,md outline Basic pathophysiology screening
More informationSummary Statement from a Workshop on Asymptomatic Primary Hyperparathyroidism: A Perspective for the 21st Century
Summary Statement from a Workshop on Asymptomatic Primary Hyperparathyroidism: A Perspective for the 21st Century John P. Bilezikian, John T. Potts, Jr., Ghada El-Hajj Fuleihan, Michael Kleerekoper, Robert
More informationParathyroid Imaging. A Guide to Parathyroid Surgery
Parathyroid Imaging A Guide to Parathyroid Surgery Primary Hyperparathyroidism (PHPT) 3 rd most common endocrine disorder after diabetes and hyperthyroidism Prevalence in women 2% Often discovered in asymptomatic
More informationTHE ASSOCIATION OF PRIMARY HYPERPARATHYROIDISM WITH DISORDERS OF THE THYROID GLAND AND CARPENTRY OUR EXPERIENCE
24 MEDICINSKI GLASNIK / str. 24-30 Snežana Marinković, Nenad Laketić 1 THE ASSOCIATION OF PRIMARY HYPERPARATHYROIDISM WITH DISORDERS OF THE THYROID GLAND AND CARPENTRY OUR EXPERIENCE Introduction Primary
More informationWhat this study adds: - Sustained hypercalacemia affects 1 in 500 children in a general hospital setting
FREQUENCY AND AETIOLOGY OF HYPERCALCAEMIA McNeilly JD 1, Boal R 2, Shaikh MG 2, Ahmed SF 2 1 Dept of Clinical Biochemistry, Queen Elizabeth University Hospital, Greater Glasgow & Clyde NHS Trust, Glasgow,
More informationDo We Do Too Many Parathyroidectomies in Dialysis? Sagar Nigwekar MD, MMSc Massachusetts General Hospital
Do We Do Too Many Parathyroidectomies in Dialysis? Sagar Nigwekar MD, MMSc Massachusetts General Hospital E-mail: snigwekar@mgh.harvard.edu March 13, 2017 Disclosures statement: Consultant: Allena, Becker
More informationMetabolic Bone Disease Related to Chronic Kidney Disease
Metabolic Bone Disease Related to Chronic Kidney Disease Deborah Sellmeyer, MD Director, Johns Hopkins Metabolic Bone Center Dept of Medicine, Division of Endocrinology Disclosure DSMB member for denosumab
More informationResearch Article Primary Hyperparathyroidism: 11-Year Experience in a Single Institute in Thailand
International Endocrinology Volume 2012, Article ID 952426, 4 pages doi:10.1155/2012/952426 Research Article Primary Hyperparathyroidism: 11-Year Experience in a Single Institute in Thailand Poramaporn
More informationInvestigations for Disorders of Calcium, Phosphate and Magnesium Homeostasis
Investigations for Disorders of Calcium, Phosphate and Magnesium Homeostasis Tutorial for Specialist Portfolio Biomedical Scientists 03/02/2014 Dr Petros Kampanis Clinical Scientist 1. Calcium Most abundant
More informationProduct: Cinacalcet HCl Observational Research Clinical Study Report: Date: 23 July 2012 Page Page 2 2 of of 1203
Date: 23 July 2012 Page Page 2 2 of of 1203 SYNOPSIS Name of Sponsor: mgen Development Europe Product or Therapeutic rea: Cinacalcet HCl Indication: The reduction of hypercalcaemia in patients with primary
More informationParathyroid Imaging What is best
Parathyroid Imaging What is best Mike Avison Bradford Why me? I m honoured to be asked to present this. There is no killer paper or text which clearly proves the best methodology. Bradford has performed
More informationBuilding Bone Density-Research Issues
Building Bone Density-Research Issues Helping to Regain Bone Density QUESTION 1 What are the symptoms of Osteoporosis? Who is at risk? Symptoms Bone Fractures Osteoporosis 1,500,000 fractures a year Kyphosis
More informationHyper and hypocalcaemia. Prof Tricia Tan
Hyper and hypocalcaemia Prof Tricia Tan Learning Objectives Basic physiology of Ca regulation Case presentations Take home messages Calcium Total body calcium content ~1300g 99% in bone 1% intracellular
More informationSouthern Derbyshire Shared Care Pathology Guidelines. MGUS (Monoclonal Gammopathy of Undetermined Significance)
Southern Derbyshire Shared Care Pathology Guidelines MGUS (Monoclonal Gammopathy of Undetermined Significance) Purpose of guideline This guideline provides information about the risk stratification of
More informationTHE THYROID. Your thyroid evaluation may include the following:
An endocrinologist is a doctor specially trained to diagnose and treat diseases affecting your glands. Glands are small organs that produce hormones, which are substances that help control various activities
More informationSupplementary Online Content
Supplementary Online Content Wilhelm SM, Wang TS, Ruan DT, et al. The American Association of Endocrine Surgeons guidelines for definitive management of primary hyperparathyroidism. JAMA Surg. Published
More informationNew 2010 Osteoporosis Guidelines: What you and your health provider need to know QUESTIONS&ANSWERS
New 2010 Osteoporosis Guidelines: What you and your health provider need to know QUESTIONS&ANSWERS Wednesday, December 1, 2010 1:00 p.m. to 2:00 p.m. ET 1. I m 55 years old. I ve been taking Fosavance
More informationParathyroidectomy. Surgery for Parathyroid Problems
Parathyroidectomy Surgery for Parathyroid Problems Why You Need Parathyroid Surgery Has your doctor just recommended that you have parathyroid surgery? If so, you likely have many questions. What are the
More informationB. Environmental Factors. a. The major risk factor to papillary thyroid cancer is exposure to ionizing radiation, during the first 2 decades of life.
B. Environmental Factors. a. The major risk factor to papillary thyroid cancer is exposure to ionizing radiation, during the first 2 decades of life. b. Deficiency of dietary iodine: - Is linked with a
More informationCKD-MBD CKD mineral bone disorder
CKD Renal bone disease Dr Mike Stone University Hospital Llandough Affects 5 10 % of population Increasingly common Ageing, diabetes, undetected hypertension Associated with: Cardiovascular disease Premature
More informationPrimary hyperparathyroidism (PHPT) CE/CME. Barbara Austin, MSN, ARNP, FNP-BC
Primary Hyperparathyroidism A Case-based Review Primary hyperparathyroidism (PHPT) is most often detected as hypercalcemia in an asymptomatic patient during routine blood work. Knowing the appropriate
More informationMinimally invasive parathyroidectomy
Minimally invasive parathyroidectomy Jessica E. Gosnell MD Assistant Professor of Surgery March 22, 2011 1 Minimally invasive parathyroidectomy 1. What? 2. When? 3. How? 4. Convert? 5. What adjuncts? Primary
More informationhyperplastic parathyroid glands
Journal of Clinical Pathology, 1978, 31, 626-632 A histological comparison of adenomatous and hyperplastic parathyroid glands D. A. S. LAWRENCE From the Department of Histopathology, Royal Free Hospital,
More informationDumfries and Galloway. Treatment Protocol for Osteoporosis
Dumfries and Galloway Treatment Protocol for Osteoporosis DIAGNOSIS OF OSTEOPOROSIS 2 Diagnostic Criteria 2 Multiple low trauma vertebral fractures in the absence of myeloma or metastatic disease. 2 T-score
More informationDisclosure. Topic Outline. Calcium, Vitamin D, PTH Disorders. PTH/Calcium-Normal Physiology. I have nothing to disclose
Disclosure Calcium, Vitamin D, PTH Disorders I have nothing to disclose Chienying Liu MD Associate Clinical Professor Division of Endocrinology & Metabolism UCSF Topic Outline Calcium/Vitamin D/PTH physiology
More informationInterpreting DEXA Scan and. the New Fracture Risk. Assessment. Algorithm
Interpreting DEXA Scan and the New Fracture Risk Assessment Algorithm Prof. Samir Elbadawy *Osteoporosis affect 30%-40% of women in western countries and almost 15% of men after the age of 50 years. Osteoporosis
More informationBone Disease after Kidney Transplantation
Bone Disease after Kidney Transplantation BTS March 2018 Dr Arif Khwaja PhD, FRCP Sheffield Kidney Institute Clinical case 47 year old female FSGS DBD 2007 egfr 25mls/min. Sirolimus, Azathioprine and prednisolone
More informationDumfries and Galloway. Treatment Protocol for Osteoporosis
Dumfries and Galloway Treatment Protocol for Osteoporosis DIAGNOSIS OF OSTEOPOROSIS 2 Diagnostic Criteria 2 REFERRAL CRITERIA FOR DEXA 3 TREATMENT 4 Non-Drug Therapy : for all 4 Non-Drug Therapy : in the
More informationOsteoporosis Clinical Guideline. Rheumatology January 2017
Osteoporosis Clinical Guideline Rheumatology January 2017 Introduction Osteoporosis is a condition of low bone mass leading to an increased risk of low trauma fractures. The prevalence of osteoporosis
More informationMarcin Barczynski, 1 Aleksander Konturek, 2 Alicja Hubalewska-Dydejczyk, 2. Filip Gołkowski, 1 Stanislaw Cichon, 1 Piotr Richter, 1 Wojciech Nowak
3 rd Chair and Department of General Surgery 1 and Chair and Department of Endocrinology 2 Jagiellonian University, Medical College Head: Prof. Wojciech Nowak, MD, PhD INTRAOPERATIVE BILATERAL INTERNAL
More informationDosage in renal impairment Kalcipos-D chewable tablets should not be used in patients with severe renal impairment.
SUMMARY OF THE PRODUCT CHARACTERISTICS 1 NAME OF THE MEDICINAL PRODUCT Kalcipos-D 500 mg/400 IU chewable tablet 2 QUALITATIVE AND QUANTITATIVE COMPOSITION One chewable tablet contains: calcium 500 mg as
More informationnogg Guideline for the diagnosis and management of osteoporosis in postmenopausal women and men from the age of 50 years in the UK
nogg NATIONAL OSTEOPOROSIS GUIDELINE GROUP Guideline for the diagnosis and management of osteoporosis in postmenopausal women and men from the age of 50 years in the UK Produced by J Compston, A Cooper,
More informationParathyroid hormone (serum, plasma)
Parathyroid hormone (serum, plasma) 1 Name and description of analyte 1.1 Name of analyte Parathyroid hormone (PTH) 1.2 Alternative names Parathormone 1.3 NMLC code 1.4 Description of analyte PTH is an
More informationDiagnosis and Treatment of Osteoporosis. Department of Endocrinology and Metabolism Ajou University School of Medicine.
Diagnosis and Treatment of Osteoporosis Department of Endocrinology and Metabolism Ajou University School of Medicine Yoon-Sok CHUNG WCIM, COEX, Seoul, 27Oct2014 Case 1 71-year old woman Back pain Emergency
More informationFor the use only of Registered Medical Practitioners or a Hospital or a Laboratory OSTOCALCIUM FORTE TABLETS
For the use only of Registered Medical Practitioners or a Hospital or a Laboratory OSTOCALCIUM FORTE TABLETS Calcium and Phosphorus with Vitamin D3 Tablets QUALITATIVE AND QUANTITATIVE COMPOSITION Each
More informationHorizon Scanning Technology Briefing. Zoledronic Acid (Aclasta) once yearly treatment for postmenopausal. National Horizon Scanning Centre
Horizon Scanning Technology Briefing National Horizon Scanning Centre Zoledronic Acid (Aclasta) once yearly treatment for postmenopausal osteoporosis December 2006 This technology summary is based on information
More informationSUMMARY OF PRODUCT CHARACTERISTICS
SUMMARY OF PRODUCT CHARACTERISTICS 1 NAME OF THE MEDICINAL PRODUCT Colecalciferol Meda 800 IU tablet 2 QUALITATIVE AND QUANTITATIVE COMPOSITION Each tablet contains colecalciferol (vitamin D 3 ) 800 IU
More informationChronic Kidney Disease Mineral Bone Disorder (CKD-MBD)
Oxford Kidney Unit Chronic Kidney Disease Mineral Bone Disorder (CKD-MBD) Information for patients This leaflet will provide you with information about chronic kidney disease mineral bone disorder (CKD-MBD)
More informationNephrology and Surgical Department Parathyroid Surgery in Adults
Nephrology and Surgical Department Parathyroid Surgery in Adults This leaflet explains surgery to treat Primary Hyperparathyroidism. It will help you to understand the operation and the care that you will
More informationPARATHYROID, VITAMIN D AND BONE
PARATHYROID, VITAMIN D AND BONE G M Kellerman Pathology North Hunter Service 30/01/2015 BIOLOGY OF BONE Bone consists of protein, polysaccharide components and mineral matrix. The mineral is hydroxylapatite,
More informationSouthern Derbyshire Shared Care Pathology Guidelines. Coeliac Disease
Southern Derbyshire Shared Care Pathology Guidelines Coeliac Disease Purpose of Guideline When and how to investigate patients for Coeliac Disease What the results mean When and how to refer patients Monitoring
More informationREFERRAL GUIDELINES ENDOCRINOLOGY
REFERRAL GUIDELINES ENDOCRINOLOGY Referral Form: The GP Referral Template is the preferred referral tool (previously known as the Victorian Statewide Referral Form) GP Referral Template This tool is housed
More informationCurrent Concepts in the Evaluation and Management of Abnormal Parathyroid Hormone (PTH) Levels Shireen Fatemi, M.D. April, 2012.
Current Concepts in the Evaluation and Management of Abnormal Parathyroid Hormone (PTH) Levels Shireen Fatemi, M.D. April, 2012 Disclosures I have no financial relationships with commercial interests,
More informationCASE PRESENTATION. Kārlis Rācenis MD - Latvia
CASE PRESENTATION Kārlis Rācenis MD - Latvia o Patient men, 32-years-old o Admitted to the hospital at 12.09.16 due to kidney biopsy no complains 21.07 29.07.2016 Admitted to the hospital Acute kidney
More information