All of the following are indications for surgical treatment of
secondary hyperparathyroidism except:
A. Calcium-phosphate product of less than 70
B. Uremic pruritus
C. Osteitis fibrosa cystica
D. Calciphylaxis
E. Tumoral calcinosis
COMMENTS: Secondary hyperparathyroidism is most commonly
managed medically with the use of calcimimetic agents,
phosphate binders, adequate calcium intake, and vitamin D replacement.
Surgical treatment is indicated in patients with (1) renal
osteodystrophy, (2) calciphylaxis, (3) calcium-phosphate product
of greater than 70, (4) soft tissue calcium deposition and tumoral
calcinosis, and (5) calcium level greater than 11 mg/dL with an
inappropriately high level of PTH. Renal osteodystrophy is a
major issue in hemodialysis patients. The aluminum present in the
dialysate bath accumulates in bone and contributes to the development
of osteomalacia. Osteitis fibrosa cystica, a type of renal
osteodystrophy, is characterized by marrow fibrosis and increased
bone turnover. Bone cysts, osteopenia, and decreased bone strength
develop. To halt progression of this disease process, these patients
with secondary hyperparathyroidism are treated surgically. Calciphylaxis
is a rare vascular disorder in which calcium is deposited
in the media of small to medium-sized arteries. As a result, ischemic
damage to the dermal and epidermal structures develops. The
ulcerated lesions are extremely painful and can become infected
with subsequent sepsis and eventually death. Patients with early
signs of calciphylaxis should undergo urgent parathyroidectomy,
although there is some evidence that aggressive management of
serum calcium and parathyroid levels with cinacalcet may be beneficial.
Care should be taken in wound care management because
aggressive débridement can lead to chronic nonhealing wounds
since wound healing is very poor in these patients. Uremic pruritus
is characterized by severe itching that is thought to result from
increased deposition of calcium salt in the dermis without the
visible lesions of calciphylaxis. Parathyroidectomy seems to alleviate
these symptoms and halts progression to the more serious skin
and vascular complications seen with calciphylaxis.
A N S W E R : A
secondary hyperparathyroidism except:
A. Calcium-phosphate product of less than 70
B. Uremic pruritus
C. Osteitis fibrosa cystica
D. Calciphylaxis
E. Tumoral calcinosis
COMMENTS: Secondary hyperparathyroidism is most commonly
managed medically with the use of calcimimetic agents,
phosphate binders, adequate calcium intake, and vitamin D replacement.
Surgical treatment is indicated in patients with (1) renal
osteodystrophy, (2) calciphylaxis, (3) calcium-phosphate product
of greater than 70, (4) soft tissue calcium deposition and tumoral
calcinosis, and (5) calcium level greater than 11 mg/dL with an
inappropriately high level of PTH. Renal osteodystrophy is a
major issue in hemodialysis patients. The aluminum present in the
dialysate bath accumulates in bone and contributes to the development
of osteomalacia. Osteitis fibrosa cystica, a type of renal
osteodystrophy, is characterized by marrow fibrosis and increased
bone turnover. Bone cysts, osteopenia, and decreased bone strength
develop. To halt progression of this disease process, these patients
with secondary hyperparathyroidism are treated surgically. Calciphylaxis
is a rare vascular disorder in which calcium is deposited
in the media of small to medium-sized arteries. As a result, ischemic
damage to the dermal and epidermal structures develops. The
ulcerated lesions are extremely painful and can become infected
with subsequent sepsis and eventually death. Patients with early
signs of calciphylaxis should undergo urgent parathyroidectomy,
although there is some evidence that aggressive management of
serum calcium and parathyroid levels with cinacalcet may be beneficial.
Care should be taken in wound care management because
aggressive débridement can lead to chronic nonhealing wounds
since wound healing is very poor in these patients. Uremic pruritus
is characterized by severe itching that is thought to result from
increased deposition of calcium salt in the dermis without the
visible lesions of calciphylaxis. Parathyroidectomy seems to alleviate
these symptoms and halts progression to the more serious skin
and vascular complications seen with calciphylaxis.
A N S W E R : A
No comments:
Post a Comment