primary hyperparathyroidism surgical approach dr mohammad alshehri, can. board, facs, d med edu....
TRANSCRIPT
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Primary hyperparathyroidism
Surgical Approach
Dr Mohammad AlShehri, Can. Board, FACS, D Med Edu.Professor of Surgery
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Physiology
•Parathormone hormone•Vitamin D
ca
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84% Adenoma
15% Hyperplasia
1% Carcinoma
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Clinical manifestations
•Renal stones•Bone and joint pains•Abdominal groans•Psychic moans•Fatigue overtones
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No symptoms
Mild symptoms
Renal symptoms
Bone symptoms
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•Statistics from Western countries indicate a 0.1-0.5% prevalence rate for PHP.
•No evidence for geographical variation
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•Commonest cause of Hpercalcaemia in society
•Uncommon in children•2-3 times in females
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Clinical presentation
•In the west 60 - 70% detected by routine screening.
•Many are asymptomatic
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Presentation
•Age 30 – 77 ( median 40)•Females 70 %•All have advanced bone disease.•54% have also renal manifestations
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•40 y old lady•# 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
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•30 y old lady•# 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
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•45 y old lady•ESRF•Advanced bone disease
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Investigations•Serum Calcium
•PTH
• Serum Phosphate
• Chloride
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Management
•All symptomatic patients should be treated
•Asymptomatic ??
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Conclusions
•PHP is a very underdiagnosed disease in Saudi Arabia.
•Patients are not diagnosed early•Complications could be serious and these
are avoidable.
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Recommendations
•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
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Thyroid diseases
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Case 1Fatima 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.
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Case 1• What could this be?• Is it a thyroid swelling?
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Movement with swallowing• Thyroid • Thyroglossal cyst
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Case 1• What could this be?• Is it a thyroid swelling?• If it is a thyroid swelling, what could be the cause of this
swelling?
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•Thyroid cyst•Multinodular goiter•Inflammatory•Benign tumor•malignancy
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Case 1• 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?
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Case 2Ahmed ( age 28 years) came to the Outpatient clinic complaining of nervousness, palpitations, sweating, and weight loss. Clinical examination revealed the presence of a goitre.
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•Graves disease•Toxic multinodular goiter•Toxic nodule
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Hyperthyroidism
•Nervousness•Wt loss + Increased appetite•Heat intolerance•Sweating•Muscular weakness•Menstrual irregularities
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Hyperthyroidism
•Goiter•Tachycardia +/-Arrhythmias•Warm moist skin•Bruit & thrill•Eye signs
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Laboratory
•Increases T4, T3•Decreased TSH
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Management
•Medical•Radio-nuclear iodine•Surgery
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Case 3Aisha 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.
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Laboratory
•Decreases T4, T3•Increased TSH
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Thyroid cancer
•Papillary•Follicular•Medullary•Undefferntiated•Lymphoma
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Papillary carcinoma
•Accounts for 85%•Appears in early adult life•Lymphatic spread•Good prognosis
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Follicular carcinoma
•Accounts for about 10%•Differentiation between benign and
malignant is not easy•Blood spread•Prognosis not as good
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Medullary carcinoma
•Accounts for about 7%•Arises from C-Cells•Familial medullary carcinoma 25%•MEN syndrome•Prognosis is not good
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Undifferntiated
•Accounts for about 1%•Rapidly growing•Locally invasive•Rarely curative
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Lymphoma
•More common in our part of the world•Usually diagnosed post op•Chemo-radiotherapy.
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•http://www.powershow.com/view/f7c3a-NzFhY/NECK_SWELLINGS_powerpoint_ppt_presentation
•http://www.youtube.com/user/ParathyroidTV?v=sD9st1ZPFrQ
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Recommendations
•Hyperparathyroidism should be included in undergraduate curriculum and certainly in residency programs.
•Developing expertise in parathyroid surgery is required.
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Post operative management
Be careful of bone hunger syndrome
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