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Hypercalcemia Primary Hyperparathyroidism

HPI: 23 year old female presented to Frankford ER on 4/22/09 from Friend's Hospital for overdose. Patient admitted to taking 8- 80 mg Oxycontin and 4- 4 mg Xanax in an attempt to kill herself. She suffers from depression and admitted to multiple other suicide attempts in the past. Meds: Denies

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Hypercalcemia Primary Hyperparathyroidism

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    1. Hypercalcemia & Primary Hyperparathyroidism Stacey DonFrancesco, MS III PCOM Grand Rounds 8/4/2009

    3. FamHx: Non-contributory SocHx: (+) Tobacco & ETOH use, denies illicit drug use PE: VS: Temp 98.4, BP 140/82, HR 99, RR 20, Wt 60.3 kg General: well nourished, NAD Eyes: PERRLA, EOMI Neck: Supple, NT, (-) thyromegaly, nonpalpable mass Lungs: CTA B/L, no wheezing/rales/rhonchi Heart: (+) S1, S2 RRR Abdomen: (+) BS, soft w/ mild suprapubic tenderness, (-) rebound/guarding Extremities: (-) edema Neuro: motor & sensory intact Mental status: AAO x 3 , normal affect

    4. Labs – 4/23/09 CBC WBC - 6.3 Plt Count – 182 Hgb 15.6, Hct 44.4 CMP Na+ 136, K+ 4.1 Cl- 104, CO2 25 BUN 11, Creat 0.78 Glucose 87 **Ca2+ 12.0

    5. Imaging Parathyroid Imaging: Technetium - 99 Sestamibi Radionuclear Scan - 4/24/2009 - Results: Findings consistent with functioning adenoma overlying lower pole of (R) lobe of thyroid

    6. Technetium-99 labeled Sestamibi Scan

    7. Technetium-99 labeled Sestamibi Scan

    8. Imaging Ultrasound of Thyroid – 4/27/2009 - Results: Complex cystic mass adjacent to right lobe of thyroid which may represent a parathyroid adenoma

    9. Ultrasound of Thyroid

    10. Ultrasound of Thyroid

    11. Pre-Op Labs – 7/8/09 CBC WBC – 8.2 Plt Count – 184 Hgb 13.9, Hct 39.3 CMP Na+ 139, K+ 4.1 Cl- 107, CO2 27 BUN 9, Creat 0.99 Glucose 79

    12. Surgical Rx - Parathyroidectomy Transverse incision was made overlying thyroid isthmus with initial division of platysma Strap muscles were retracted laterally, middle thyroid vein was identified, ligated, and tied off. Right inferior lobe parathyroidectomy was performed with removal of parathyroid adenoma Adenoma was sent to pathology for confirmation of complete removal before closing

    13. Preop Diagnosis: Hyperparathyroidism Postop Diagnosis: Hyperparathryoidism 2° to parathyroid adenoma Procedure: Right Inferior Lobe Parathyroidectomy Anesthesia: GETA EBL: 5 mL Fluids: 1200 mL Specimen: Right inferior parathyroid gland Drains: None Complications: None Condition: Stable Operative Note

    14. Post-Op Labs – 7/17/09 **Ca2+ - 9.7 PTH – 12.5 Mg – 2.2 VS - Stable - 98 98/58 55 20

    15. Post-Op Course POD #1 Labs Ca2+ = 8.7 Mg = 1.9 PE – no hoarseness or dysphagia Started on clear liquid diet POD #2 Patient did well, tolerated regular diet Discharged on calcium supplements Pathology report demonstrated parathyroid adenoma

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