Primary hyperparathyroidism surgical approach
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Primary hyperparathyroidism Surgical Approach. Dr Mohammad AlShehri, Can. Board, FACS, D Med Edu. Professor of Surgery. Physiology. Parathormone hormone Vitamin D. ca. Clinical manifestations. Renal stones Bone and joint pains Abdominal groans Psychic moans Fatigue overtones.

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Primary hyperparathyroidism surgical approach

Primary hyperparathyroidism Surgical Approach

Dr Mohammad AlShehri, Can. Board, FACS, D Med Edu.

Professor of Surgery


Physiology
Physiology

  • Parathormone hormone

  • Vitamin D

ca


Clinical manifestations
Clinical manifestations

  • Renal stones

  • Bone and joint pains

  • Abdominal groans

  • Psychic moans

  • Fatigue overtones


No symptoms

Mild symptoms

Renal symptoms

Bone symptoms




Clinical presentation
Clinical presentation prevalence rate for PHP.

  • In the west 60 - 70% detected by routine screening.

  • Many are asymptomatic


Presentation
Presentation prevalence rate for PHP.

  • Age 30 – 77 ( median 40)

  • Females 70 %

  • All have advanced bone disease.

  • 54% have also renal manifestations


  • 40 y old lady prevalence rate for PHP.

  • # Lt humerous

  • Lt Ureteric stone removed 6 y back

  • Rt Ureteric stone removed 3 y back

  • Non functioning Lt kidney

  • S Ca 11.2mg/dl P 2.2mg/ dl


  • 30 y old lady prevalence rate for PHP.

  • # Rt Radius

  • Long H/O generalized bone ache, heart burn & easy fatigue.

  • Lt ureteric stone removed 5 y back

  • S Ca 14.3 mg/dl p 2.4mg/dl


  • 45 y old lady prevalence rate for PHP.

  • ESRF

  • Advanced bone disease


Investigations
Investigations prevalence rate for PHP.

  • Serum Calcium

  • PTH

  • Serum Phosphate

  • Chloride


Management
Management prevalence rate for PHP.

  • All symptomatic patients should be treated

  • Asymptomatic ??


Conclusions
Conclusions prevalence rate for PHP.

  • PHP is a very underdiagnosed disease in Saudi Arabia.

  • Patients are not diagnosed early

  • Complications could be serious and these are avoidable.


Recommendations
Recommendations prevalence rate for PHP.

  • The medical community needs to be more aware of the disease.

  • Specifically the diagnosis should be considered in patients with

    • bilateral or recurrent renal stones

    • patients with suggestive radiological bone changes

    • and naturally in patients with high serum calcium level


Thyroid diseases

Thyroid diseases prevalence rate for PHP.


Case 1
Case 1 prevalence rate for PHP.

Fatima is a 30-year old Saudi lady that presented to the Outpatient clinic, complaining of a swelling in the midline of her neck that she had for 2 months.


Case 11
Case 1 prevalence rate for PHP.

  • What could this be?

  • Is it a thyroid swelling?


Movement with swallowing
Movement with swallowing prevalence rate for PHP.

  • Thyroid

  • Thyroglossal cyst


Case 12
Case 1 prevalence rate for PHP.

  • What could this be?

  • Is it a thyroid swelling?

  • If it is a thyroid swelling, what could be the cause of this swelling?


  • Thyroid cyst prevalence rate for PHP.

  • Multinodular goiter

  • Inflammatory

  • Benign tumor

  • malignancy


Case 13
Case 1 prevalence rate for PHP.

  • What could this be?

  • Is it a thyroid swelling?

  • If it is a thyroid swelling, what could be the cause of this swelling?

  • What points in history, in clinical examination, and investigation will help you to differentiate between all these causes of thyroid swelling?


Case 2
Case 2 prevalence rate for PHP.

Ahmed ( age 28 years) came to the Outpatient clinic complaining of nervousness, palpitations, sweating, and weight loss. Clinical examination revealed the presence of a goitre.


  • Graves disease prevalence rate for PHP.

  • Toxic multinodular goiter

  • Toxic nodule


Hyperthyroidism
Hyperthyroidism prevalence rate for PHP.

  • Nervousness

  • Wt loss + Increased appetite

  • Heat intolerance

  • Sweating

  • Muscular weakness

  • Menstrual irregularities


Hyperthyroidism1
Hyperthyroidism prevalence rate for PHP.

  • Goiter

  • Tachycardia +/-Arrhythmias

  • Warm moist skin

  • Bruit & thrill

  • Eye signs


Laboratory
Laboratory prevalence rate for PHP.

  • Increases T4, T3

  • Decreased TSH


Management1
Management prevalence rate for PHP.

  • Medical

  • Radio-nuclear iodine

  • Surgery


Case 3
Case 3 prevalence rate for PHP.

Aisha is a 55-year old lady that presented to your clinic. Her main complaint is related to some recent difficulty in hearing. The family noticed that she started to have difficulty in understanding, that she gained weight, and her voice started to be coarse.


Laboratory1
Laboratory prevalence rate for PHP.

  • Decreases T4, T3

  • Increased TSH


Thyroid cancer
Thyroid cancer prevalence rate for PHP.

  • Papillary

  • Follicular

  • Medullary

  • Undefferntiated

  • Lymphoma


Papillary carcinoma
Papillary carcinoma prevalence rate for PHP.

  • Accounts for 85%

  • Appears in early adult life

  • Lymphatic spread

  • Good prognosis


Follicular carcinoma
Follicular carcinoma prevalence rate for PHP.

  • Accounts for about 10%

  • Differentiation between benign and malignant is not easy

  • Blood spread

  • Prognosis not as good


Medullary carcinoma
Medullary carcinoma prevalence rate for PHP.

  • Accounts for about 7%

  • Arises from C-Cells

  • Familial medullary carcinoma 25%

  • MEN syndrome

  • Prognosis is not good


Undifferntiated
Undifferntiated prevalence rate for PHP.

  • Accounts for about 1%

  • Rapidly growing

  • Locally invasive

  • Rarely curative


Lymphoma
Lymphoma prevalence rate for PHP.

  • More common in our part of the world

  • Usually diagnosed post op

  • Chemo-radiotherapy.



Thank youhttp://www.powershow.com/view/f7c3a-NzFhY/NECK_SWELLINGS_powerpoint_ppt_presentation

[email protected]

Twitter @myshehri


Recommendations1
Recommendationshttp://www.powershow.com/view/f7c3a-NzFhY/NECK_SWELLINGS_powerpoint_ppt_presentation

  • Hyperparathyroidism should be included in undergraduate curriculum and certainly in residency programs.

  • Developing expertise in parathyroid surgery is required.


Post operative management
Post operative managementhttp://www.powershow.com/view/f7c3a-NzFhY/NECK_SWELLINGS_powerpoint_ppt_presentation

Be careful of bone hunger syndrome


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