Pathology Notes

Practice questions answers Pathology of parathyroid gland/MEN © Jun Wang, MD, PhD 1. C. The causes of hypercalcemia are variable. The first laboratory test for patient with hypercalcemia, as recommended by American Academy of Family Physicians , is intact parathyroid hormone (PTH). Bone marrow biopsy and immunofixation are for multiple myeloma , plasmacytoma and other lymphoid neoplasms . These disorders commonly have abnormal urine immunoglobulins. MRI breast examination may be used to detect recurrent breast cancers . Parathyroid hormone related peptide may be produce by solid tumors, such as squamous cell carcinoma of lung . 2. B. Elevated PTH in a patient with hypercalcemia is either primary or tertiary hyperparathyroidism . However, tertiary hyperparathyroidism is defined as autonomous hypersecretion of parathyroid hormone in a patient with long standing secondary hyperparathyroidism .   This patient does not have any secondary hyperparathyroidism associated hi

Practice questions Pathology of parathyroid gland/MEN © Jun Wang, MD, PhD 1. Use this case for the next five questions. A 58-year-old woman presents with abdominal pain for 2 weeks. She has had intermittent vomiting, diarrhea, fatigue and vague bone pains for 2 months. She has a history of invasive ductal carcinoma of left breast with axillary lymph node metastasis at age 48 that was treated with surgery and chemotherapy. Physical examination reveals no significant abnormalities, except signs of previous surgery. Laboratory test reveals serum calcium at 12.3 mg/dl (normal 8.5-10.2 mg/dl), phosphorus at 1.7 mg/dl (normal 2.5-4.5 mg/dl) and alkaline phosphatase at 575 U/L (normal 30-120 U/L). Other routine laboratory tests, including CBC and urinalysis, are within normal range. Radiologic studies reveals multiple well circumscribed lytic bone lesions at both hands and mandible. What is the appropriate next test? A. Bone marrow biopsy B. Immunofixation for serum prote

Tertiary hyperparathyroidism   Updated: 07/02/2023 © Jun Wang, MD, PhD General features Autonomous hypersecretion of PTH due to parathyroid hyperplasia/adenoma arising from longstanding secondary hyperparathyroidism Some authorities reserve the term for secondary hyperparathyroidism that persists after successful renal transplantation Often detected after hemodialysis or transplantation corrects the renal disease Clinical presentations History of secondary hyperparathyroidism Presentation of underlying disorders Possible diffuse calcinosis Key laboratory findings Abnormalities of underlying disorder, such as abnormal renal function test Elevated levels of PTH High serum phosphorus Elevated calcium Treatment Surgery Back to parathyroid pathology Back to pathology of endocrine system Back to contents