Paeds Cases · endocrinology-diabetes-and-growth
Hypercalcaemia and hyperparathyroidism — structured clinical encounter
Structured encounter testing the approach to an adolescent with stones, bone pain and an inappropriately normal parathyroid hormone: the PTH fork, the urine calcium-to-creatinine clearance ratio, the localising work-up, parathyroidectomy with intraoperative hormone monitoring, and the hungry bone syndrome that follows.
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Station brief (candidate)
You are the paediatric registrar. A 14-year-old boy presents with six months of renal colic, bone pain and fatigue. His corrected calcium is 2.9 mmol per litre, his phosphate is low, and his intact parathyroid hormone is inappropriately normal rather than suppressed. A urine calcium-to-creatinine clearance ratio is 0.02. A sestamibi scan shows a single focus of uptake at the lower left pole of the thyroid. The team asks you to confirm the diagnosis, arrange the remaining investigations, plan the treatment, and speak with the family. You have 12 minutes with the team and 5 minutes for examiner discussion. [4]
References6ShowHide
- [1]Bilezikian JP; Khan AA; Silverberg SJ; Fuleihan GE; et al Evaluation and Management of Primary Hyperparathyroidism: Summary Statement and Guidelines from the Fifth International Workshop J Bone Miner Res, 2022.PMID 36245251
- [2]Khan AA; Hanley DA; Rizzoli R; Bollerslev J; et al Primary hyperparathyroidism: review and recommendations on evaluation, diagnosis, and management. A Canadian and international consensus Osteoporos Int, 2017.PMID 27613721
- [3]Marcocci C; Bollerslev J; Khan AA; Shoback DM Medical management of primary hyperparathyroidism: proceedings of the fourth International Workshop on the Management of Asymptomatic Primary Hyperparathyroidism J Clin Endocrinol Metab, 2014.PMID 25162668
- [4]Kollars J; Zarroug AE; van Heerden J; Lteif A; et al Primary hyperparathyroidism in pediatric patients Pediatrics, 2005.PMID 15805373
- [5]Marx SJ; Simonds WF; Agarwal SK; Burns AL; et al Hyperparathyroidism in hereditary syndromes: special expressions and special managements J Bone Miner Res, 2002.PMID 12412776
- [6]Pidasheva S; Canaff L; Simonds WF; Marx SJ; et al Impaired cotranslational processing of the calcium-sensing receptor due to signal peptide missense mutations in familial hypocalciuric hypercalcemia Hum Mol Genet, 2005.PMID 15879434