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HPI: 23 year old female presented to Frankford ER on 4/22/09 from Friend's Hospital for overdose. Patient admitted to taking 8- 80 mg Oxycontin and 4- 4 mg Xanax in an attempt to kill herself. She suffers from depression and admitted to multiple other suicide attempts in the past. Meds: Denies
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1. Hypercalcemia & Primary Hyperparathyroidism Stacey DonFrancesco, MS III
PCOM Grand Rounds
8/4/2009
3. FamHx: Non-contributory
SocHx: (+) Tobacco & ETOH use, denies illicit drug use
PE:
VS: Temp 98.4, BP 140/82, HR 99, RR 20, Wt 60.3 kg
General: well nourished, NAD
Eyes: PERRLA, EOMI
Neck: Supple, NT, (-) thyromegaly, nonpalpable mass
Lungs: CTA B/L, no wheezing/rales/rhonchi
Heart: (+) S1, S2 RRR
Abdomen: (+) BS, soft w/ mild suprapubic tenderness, (-) rebound/guarding
Extremities: (-) edema
Neuro: motor & sensory intact
Mental status: AAO x 3 , normal affect
4. Labs – 4/23/09 CBC
WBC - 6.3
Plt Count – 182
Hgb 15.6, Hct 44.4
CMP
Na+ 136, K+ 4.1
Cl- 104, CO2 25
BUN 11, Creat 0.78
Glucose 87
**Ca2+ 12.0
5. Imaging Parathyroid Imaging: Technetium - 99 Sestamibi Radionuclear Scan - 4/24/2009
- Results: Findings consistent with functioning adenoma overlying lower pole of (R) lobe of thyroid
6. Technetium-99 labeled Sestamibi Scan
7. Technetium-99 labeled Sestamibi Scan
8. Imaging Ultrasound of Thyroid – 4/27/2009
- Results: Complex cystic mass adjacent to right lobe of thyroid which may represent a parathyroid adenoma
9. Ultrasound of Thyroid
10. Ultrasound of Thyroid
11. Pre-Op Labs – 7/8/09 CBC
WBC – 8.2
Plt Count – 184
Hgb 13.9, Hct 39.3
CMP
Na+ 139, K+ 4.1
Cl- 107, CO2 27
BUN 9, Creat 0.99
Glucose 79
12. Surgical Rx - Parathyroidectomy Transverse incision was made overlying thyroid isthmus with initial division of platysma
Strap muscles were retracted laterally, middle thyroid vein was identified, ligated, and tied off.
Right inferior lobe parathyroidectomy was performed with removal of parathyroid adenoma
Adenoma was sent to pathology for confirmation of complete removal before closing
13. Preop Diagnosis: Hyperparathyroidism
Postop Diagnosis: Hyperparathryoidism 2° to parathyroid adenoma
Procedure: Right Inferior Lobe Parathyroidectomy
Anesthesia: GETA
EBL: 5 mL
Fluids: 1200 mL
Specimen: Right inferior parathyroid gland
Drains: None
Complications: None
Condition: Stable
Operative Note
14. Post-Op Labs – 7/17/09 **Ca2+ - 9.7
PTH – 12.5
Mg – 2.2
VS - Stable
- 98 98/58 55 20
15. Post-Op Course POD #1
Labs
Ca2+ = 8.7
Mg = 1.9
PE – no hoarseness or dysphagia
Started on clear liquid diet
POD #2
Patient did well, tolerated regular diet
Discharged on calcium supplements
Pathology report demonstrated parathyroid adenoma