Phys Vivas · renal
Electrolyte Disorders (Calcium, Magnesium, Phosphate) — Viva Defence
Structured DCE viva for divalent ion disorders: long-case defence of asymptomatic hypercalcaemia with inappropriately normal PTH on a thiazide — the operate-or-monitor discussion in primary hyperparathyroidism, with the thiazide and FHH confounders.
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Opening statement (SASPOP, delivered aloud)
"Mrs Ward is a 72-year-old retired teacher with persistent asymptomatic mild hypercalcaemia and an inappropriately normal PTH — biochemistry that, once confounders are addressed, is most consistent with primary hyperparathyroidism. Her main problems are: first, confirming the diagnosis, which means dealing with the thiazide confounder and excluding familial hypocalciuric hypercalcaemia; second, her osteoporosis, where a femoral neck T-score of −2.6 technically meets a surgical criterion; and third, a genuine shared decision about parathyroidectomy versus surveillance in a well woman in her seventies. I would like to confirm the biochemistry cleanly, complete the stone-and-fracture screen, and then decide with her, not for her." [1]
References6ShowHide
- [1]Bilezikian JP, Brandi ML, Eastell R, et al. Guidelines for the management of asymptomatic primary hyperparathyroidism: summary statement from the Fourth International Workshop J Clin Endocrinol Metab, 2014.PMID 25162665
- [2]Christensen SE, Nissen PH, Vestergaard P, et al. Familial hypocalciuric hypercalcaemia: a review Curr Opin Endocrinol Diabetes Obes, 2011.PMID 21986511
- [3]Minisola S, Pepe J, Piemonte S, et al. The diagnosis and management of hypercalcaemia BMJ, 2015.PMID 26037642
- [4]Marx SJ. Familial Hypocalciuric Hypercalcemia as an Atypical Form of Primary Hyperparathyroidism J Bone Miner Res, 2018.PMID 29115694
- [5]Carroll MF, Schade DS. A practical approach to hypercalcemia Am Fam Physician, 2003.PMID 12751658
- [6]Holick MF. Vitamin D deficiency N Engl J Med, 2007.PMID 17634462