Clinical Scenario- Parathyroid GlandDANISH HASSANLECTURER, UNIVERSITY OF SARGODHA

Case # 01 A 43-year-old male is admitted to the

emergency room for severe pain in his left flank, radiating to the groin. The pain is intermittent and initiated after running a marathon on a hot summer day. The patient is asked for a urine specimen and blood is detected in the urine. He is hydrated and additional diagnostic procedures are done. Laboratory values show an increased plasma calcium of 12 mg/dL, and increased plasma intact PTH values of 130 pg/mL.

Q: Which of the following findings would be predictable in this patient?

A. increased plasma phosphateB. increased serum alkaline phosphataseC. increased intestinal calcium lossD. decreased urinary calcium excretion

Q: In the patient described above, the mechanism underlying the abnormalities observed is

A. increased calcitonin releaseB. decreased hepatic 25-hydroxylase activityC. increased osteoclast apoptosisD. increased bone resorption

Case # 02 A 73-year-old woman is admitted to the hospital

following a bout of severe vomiting and generalized weakness. Initial laboratory values reveal increased plasma calcium levels. The referring physician tells you that she has breast cancer and her bone scan indicates metastasis to bone.

Q: Which of the following blood laboratory values would be compatible with this clinical scenario?

A. low PTH and phosphate, and high alkaline phosphatase

B. high PTH and phosphate, and low alkaline phosphatase

C. low PTH and phosphate, and low alkaline phosphataseD. low PTH and phosphate, and normal alkaline

phosphatase

Q: The most likely cause of hypercalcemia in the patient described in Question is

A. increased PTH productionB. increased responsiveness of the PTH receptor

1C. increased PTHrP productionD. increased calcitonin release

Q: Hyperventilation usually leads to muscle cramping (tetanic contractions). What is the physiologic concept that explains what happens in that situation?

A. hypercalcemia secondary to PTH-mediated bone resorption

B. increased dissociation of protein-bound calciumC. decreased ionized plasma calcium levelsD. increased renal calcium excretion

Case # 03 A postmenopausal patient is referred for

asymptomatic hypercalcemia and history of repeated episodes of urolithiasis (kidney stones). Blood laboratory values reveal increases in intact PTH, 1,25(OH)2D, and markers of bone resorption. Neck ultrasound revealed a mass below the right lobe of the thyroid gland.

Q: What is your most probable diagnosis? Q: What is the pathophysiology underling

increases in intact PTH, 1,25(OH)2D, and markers of bone resorption in the blood of this patient?

Q: What is the patho-physiology underling the development of kidney stones in this patient?

Case # 04 A 35-year-old woman undergoes a thyroidectomy for

papillary serous thyroid cancer. The surgeon suspects that the parathyroid glands have been removed. Which of the following findings is most likely to be seen in the patient 1 week postoperatively? A. Coma B. Constipation C. Esophagitis D. Muscle spasms and tetany