Imaging Gross Pathology Micro Pathology
A 56-year-old white female complains of severe, colicky left flank pain radiating to the groin and inner thigh and associated with nausea, vomiting, and bloody urine.
Calcium deposits in cornea (= BAND KERATOPATHY); left flank tenderness; thick fingernails; decreased muscle tone.
UA: hematuria; elevated urine calcium and phosphorus. ECG: short Q-T. Lytes: elevated serum calcium and alkaline phosphatase; low serum phosphorus; elevated PTH.
KUB: stone in left renal pelvis. XR-Plain: subperiosteal resorption of bone in fingers and teeth; chondrocalcinosis; multiple cystic bone lesions (= OSTEITIS FIBROSA CYSTICA).
Adenoma: usually involvement of one gland only; hyperplasia: all four glands enlarged; metastatic calcification may involve many sites, including lungs.
Adenoma: involvement of chief cells compressing surrounding gland, producing atrophy; hyperplasia: involvement of chief or clear cells (wasserhelle type); lack of normal fat tissue.
Surgical exploration and biopsy; parathyroidectomy; rule out malignancy.
Most commonly caused by adenomas; hyperplasia and malignancy are less common causes. Usually asymptomatic and discovered 011 routine lab check-up. Symptoms result from hypercalcemia and include renal stones, polyuria, bone pain, constipation, nausea, vomiting, lethargy, peptic ulcers, mental status changes, and pancreatitis.
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