Sin título

Hyperparathyroidism

• Dr Mohd Ariff Hafizi bin Fouzi

Diapositiva 2

patient's profile

• Name: Ms J
• Age: 61 y/o
• Gender: female
• Ethnicity: Malay
• I/C: 560630-11-5132
• Mrn: HSNZ00317084

patient background

• 61 y/o malay lady
• u/l 1)Type II DM x 12 years
• - complicated with mild NPDR
• - latest HbA1c 9.3(24/1/18)
• on s/c actrapid 8u tds
• - s/c insulatard 26u on
• - t. metformin 500mg bd
• 2)HPT/HPL
• 3) persistent tinnitus with hyperacusis
• - refused hearing aid
• ** under KK Marang f/up

latest medication

• current meds:
• - t. prazosin 0.5mg bd
• - t. perindopril 8mg od
• - t. aspirin 75mg od
• - t. atorvastatin 20mg on
• - t. amitryptilline 20mg on
• - s/c actrapid 8u tds
• - s/c insulatard 26u on
• - t. metformin 500mg bd

past medical history

• - h/o admisison on february 2018 for lethargy and polyuria
• - noted incidental finding of hypercalcemia during KK f/up
• - corrected ca 3.24, po4 0.75
• - IPTH 11.34(taken when calcium 3.02)
• - upon discharge, ca 2.6, albumin normal
• - no pamidronate given, hyration via iv drips 8 pint/24h
• - previously on thiazide, was off during admission on feb 2018
• - also noted urine ca 8.82(high)

chief complaints

• intermittent polyuria
• - 8-10x per day 3-4x at night
• - no LOA/LOW
• + intermittent right loin pain x 3/12
• o/w no constipation
• no blurring of vision
• no nocturia
• no bone pain
• no abdominal pain
• no h/o passing out stone
• no family h/o hypercalcemia
• deny usage of commercial cosmetic/traditional medication/antipsychotic

physical examination

• o/e: alert, conscious, not tachypneic, crt< 2 sec, good pulse volume
• bp 150/84
• pr 58
• t 27
• rr 20, spo2 96% under RA
• lungs: a/e equal, clear
• cvs s1 s2
• pa soft, no mass palpable
• no cervical/axillary/inguinal LN palpable

investigation

• PO4: 0.75--> 0.55, Mg 0.57, corrected Ca 3.04
• ESR 34, FBS 8.1, alb: 37--> 40
• FBC: twbc: 6.4 hb 13.1 plt 268
• BUN 3.7 creat 92 na 139 k 4.5
• ALP 100, ALT 36
• tumor marker
• ca 125: 2.1
• ca 15.3: 11.9
• ca 19-9: 30.8
• CEA 1.7

investigation

• 24h urine calcium: 7.48(high)
• serum intact parathyroid hormone: 11.31pmol/L( ref range 1.58-6.03)---(High)

chest x-ray

Diapositiva 12

Diapositiva 13