A 55-Year-Old Man With Recurrent Sharp Flank Pain

Jyoti Wadhwa, MBBS, MD; Madhavi Tripathi, MBBS, MD; Madhur Kumar Srivastava, MBBS


September 14, 2017

Whether or not the disease should be treated surgically is the critical question in the management of hyperparathyroidism. The guidelines issued in 2002 for the surgical treatment of patients with asymptomatic hyperparathyroidism include a serum calcium 1 mg/dL above the upper limit of normal, a 24-hour urinary calcium greater than 400 mg, a creatinine clearance reduced by 30% or more, a bone mineral density T score of less than -2.5 at any site, or a patient age of less than 50 years.[7]

Parathyroid ultrasonography and technetium-99m sestamibi scans using single-photon emission CT (SPECT) are used preoperatively to predict the location of abnormal glands. Intraoperative sampling of PTH levels before and at 5-minute intervals after the removal of a suspected adenoma is used to confirm a rapid fall (>50%) in PTH to normal levels. Frequent assessment of the patient's calcium level is prudent because postoperative transient hypocalcemia is common. Patients with hyperparathyroidism who do not undergo parathyroid surgery should have their serum calcium levels screened biannually, and their serum creatinine levels and bone density measurements should be checked annually.[8,9,10]

The patient in this case was found to have adenoma in the left inferior parathyroid gland, which was surgically resected. His serum calcium and phosphorus levels normalized postoperatively. On a follow-up visit, he reported being asymptomatic and without any recurrent episodes of nephrolithiasis.


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