Physical Assessments & Diagnostics

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Physical Assessments

  • irregular heart rhythm

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  • increased blood pressure
  • abdominal pain on palpation - diffuse
  • noticed weight loss (if patient is a regular patient)
  • moist skin
  • pain on palpation (skin, bones and joints)
  • pain when asked to bear weight
  • gait abnormalities

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  • hyperactive deep-tendon reflexes
  • poor coordination
  • positive mini mental exam (delirium, confusion)
  • emotional instability (irritable, depressed)

Diagnostics

  • Elevated PTH
  • Elevated calcium >10mg/dl
  • Lowered phosphorus <10mg/dl
  • UA for urine calcium
  • Elevated amylase for pancreatitis
  • Elevated alkaline phosphatase for bone disease
  • DEXA scan to identify osteoporosis
  • Genetic testing if existence of family history: MENIN and RET gene testing
  • Rule out vitamin D deficiency, renal disease, and familial hypocalcuric hypercalcemia

Localizing adenomas (since most common cause of PHPT)

  • US, CT, MRI
  • Sestimibi scan - adenomas have increased uptake after injection of 99mTc-sestamibi

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