Management of Primary Hyperparathyroidism

by Carlo Raj, MD

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    The management of primary hyperparathyroidism, what you do here is you, pre-operatively, you try to localizing getting baseline of your PTH. Do a Sestamibi Scan. I showed you a picture of a Sestamibi Scan where there was a solitary adenoma of the parathyroid. If you’ve forgotten, please take a look at the previous discussion where I very much showed you that, that’s important. Ultrasound could also help with establishing your baseline. Indication of parathyroidectomy, so if you actually need to remove the parathyroid because of this excess calcium, what are the indications? Symptomatic hypercalcemia; calcium at least 1 milligram per decilitre greater than normal; age under the age of 50, 24 urine calcium of being greater than 400 milligrams. The bone density here, unfortunate well, not show enough bone because of increased osteoclastic activity and the calcium stones are found in the kidney. All of these to you represent hypercalcemia. Whenever your patient starts becoming symptomatic with hypercalcemia and you know for a fact that it’s being caused by primary hyperparathyroidism, it’s time for you to start thinking about moving the parathyroid now. What you find to be interesting is anytime that you start doing surgery upon an organ, what is the possibility always? There is every possibility that you might take out too many parathyroids; you might take out too much of that organ is my point. If you take out too much of the organ or you might have collateral damage, say there’s a nerve passing through there, but in this case, if you take out too much parathyroid, then your patient is rendered hypoparathyroid. And if the patient is suffering from hypoparathyroidism, obviously, hypocalcemia maybe tetany. A surgical excision, do… immediate 10 minutes after excising, what you think is the adenoma. The PTH half-life is only about...

    About the Lecture

    The lecture Management of Primary Hyperparathyroidism by Carlo Raj, MD is from the course Parathyroid Gland Disorders.

    Author of lecture Management of Primary Hyperparathyroidism

     Carlo Raj, MD

    Carlo Raj, MD

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