flank pain

Discussion in 'MRCS Forum' started by Lona., Feb 4, 2008.

  1. Lona.

    Lona. Guest

    Q. A 52-year-old woman sees her physician with complaints of fatigue, headache, flank pain, hematuria, and abdominal pain. Which is most suggestive of her diagnosis?
    a- Serum acid phosphatase above 120 IU/L
    b- Serum alkaline phosphatase above 120 IU/L
    c- Serum calcium above 11 mg/dl
    d- Urinary calcium below 100 mg/day
    e- Parathyroid hormone levels below 5 pmol/L
  2. Lona.

    Lona. Guest

    Answer: c. (Norton, Ann Surg 215:297-299, 12) Primary hyperparathyroidism is a common disease, with over 100,000 new cases diagnosed each year in the United States, usually in women. Essential to the diagnosis of hyperparathyroidism is the finding of hypercalcemia. Though there are many causes of hypercalcemia, hyperparathyroidism is by far the most prevalent. With rare exceptions, operations for primary hyperparathyroidism should not be performed unless the patient is hypercalcemic. Parathyroid hormone (PTH) is not invariably elevated, but it should be relative to the serum calcium level. Ordinarily, high serum calcium levels suppress parathyroid secretion. Therefore, in the presence of hypercalcemia, normal levels of PTH are actually abnormal. Patients with primary hyperparathyroidism have either normal or elevated urinary calcium. As the name suggests, patients with familial hypocalciuric hypercalcemia (FHH) have hypercalcemia. They also usually have elevated PTH, by surgery is not indicated in this relatively rare setting of hypercalcemia.

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