Transcript The significance of early detection, diagnosis and treatment of

The significance of early detection,
diagnosis and treatment of
asymptomatic primary
hyperparathyroidism in primary
health care
Dr Aleksandra Ješić
Dr Aleksandra Kosojević
Dr Ljiljana Jandrić
Health Center“Novi Beograd“
Belgrade, Serbia
• Primary hyperparathyroidism occurs as a result of
increased and uncontrolled secretion of parathyroid
hormone due to hyper function of one or more
paratiorid glands. Primary hyperparathyroidism is the
third most common endocrine disease with the highest
incidence among women in the postmenopausal
period.
• Women are affected two to three times more often
than men, especially menopausal women with a
prevalence of 21 / 1000 women aged between 55 and
75 years. Side effects of php on bone tissue are of
particular interest in a group of women in post
menopause.
Case Report
• The patient, born in 1953, comes to family
doctor complaining of pain in her leg muscles,
constant fatigue, and sleepiness, pain in the
spine ls, as well as occasional bloating and
nausea.
• Records from the health records of associated
diseases show that the patient has treated
and controlled primary hypertension and
acute gastritis.
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Basic laboratory analysis:
Alkaline phosphates 51 U/L (100-290 U /L)
Potassium 3.9 mml/l (4.0-5.2)
Other in reference limits
ECG: sinus rhythm, Fr 57/min, longer qt interval, shallow t
waves
Ta 145/95 mm hg
Echo abdomen with no signs of renal calculi and gallbladder
Rtg l-s spine: signs of diffuse osteoporosis without cyst
formation
Sent to physiatrist
Physiatrist
• Finding dEXA; t score l-s spine -2.6(Osteoporosis)
• Ca in urine /24 h 10.22mml/24 h (2.50-8.00)
• P/S Calcium total 2.29 mml/l (2.2-2.7)
• P/S inorganic phosphate 0.83 mmol/ l (0.80-1.45)
• Phosphate in urine /24 h 21.11 mmol/24 h (1342)
• PTH 118 pg/l (16-87)
• Vitamin d 25 OH 133.1 (75-250)
• Sent to endocrinologist
Endocrinologist
• Echo thyroid: Struma mycronodosa gl.
Thyroidae.Eythyreosis
• Therapy: Bisphosphonates + vitamin d3 +
caco3
• Parathyroid gland scintigraphy: no signs of
hyperplasia, adenoma or cancer
• After two years of regular monitoring and
control at 6 months the patient feels better
without pain in ls spine and muscles.
• Control Dexa ls spine: -1.9 t score
(Osteopenia)
• PTH: 70.9(12-72)
• Primary hyperparathyroidism is a rare disease
that should always be followed in a family
doctor's office for postmenopausal women or
dominant hypercalcaemia or hypercalciuria.
• Take detailed history records, do clinical
examination of the patient, also do on time
diagnostic evaluation which will lead to the
final diagnosis.
Thank you for your attention
[email protected]