35 Questions
What should be done before diagnosing normocalcemic primary hyperparathyroidism?
Perform a thorough search for causes of secondary hyperparathyroidism, especially vitamin D deficiency
Which of the following statements about normocalcemic primary hyperparathyroidism is true, according to the text?
It is considered a nascent form of hyperparathyroidism
What should be considered for patients suspected of having normocalcemic primary hyperparathyroidism?
Regular monitoring for progression of the disease, with surgery considered for development of symptoms
Which of the following statements about primary hyperparathyroidism is true, based on the information provided?
Its incidence is approximately 1/1000, with a predilection for postmenopausal women
According to the information provided, what should be ruled out in patients suspected of having normocalcemic primary hyperparathyroidism?
Renal leak hypercalciuria
Based on the information provided, which of the following statements is true regarding the diagnosis of primary hyperparathyroidism?
It is a biochemical diagnosis based on calcium and PTH levels
What is the most common manifestation of Hyperparathyroidism-Jaw Tumor Syndrome (HPT-JT)?
Ossifying mandibular fibromas
In Familial Hypercalcemic Hypocalciuria (FHH), what is the ratio of 24-hour urine calcium to creatinine clearance expected to be?
Less than 0.01
What is the main genetic association with Neonatal Severe Hyperparathyroidism (NSHPT)?
CASR gene
Which autosomal dominant syndrome presents with hypercalcemia and hypercalcuria?
Autosomal Dominant Mild Hyperparathyroidism
What is the distinguishing feature between Familial Isolated Hyperparathyroidism (FIHPT) and other syndromes mentioned?
Presentation of kidney stones
Which syndrome should be considered when patients present with asymptomatic nonprogressive lifelong hypercalcemia?
Familial Hypercalcemic Hypocalciuria
What should patients with symptoms of emotional complaints, muscular fatigue, and constipation be screened for?
Hyperparathyroidism
What is the threshold for calcium level above the upper limit of normal, as per the NIH Consensus Guidelines for Asymptomatic Hyperparathyroidism?
0.25 mmol/L
In the context of hyperparathyroidism, what does a DEXA revealing a T score greater than −2.5 indicate?
Osteoporosis
What is the recommended creatinine clearance level for considering surgical management of Asymptomatic Hyperparathyroidism?
Less than 60 mL/min
For patients with Asymptomatic Hyperparathyroidism, what is the significance of having kidney stones or nephrocalcinosis on imaging?
Increased stone risk on stone analysis
In the preoperative evaluation of hyperparathyroidism, what is normocalcemic HPT characterized by?
Elevated PTH level with high normal calcium level
How do the NIH Consensus Guidelines generally favor surgical management in patients with Asymptomatic Hyperparathyroidism?
Young, healthy patients or older patients with disease sequelae
What is the primary advantage of using MRI for detecting parathyroid lesions?
MRI does not require the use of iodinated contrast agents.
What is the recommended imaging technique if sestamibi and ultrasound exams are negative or discordant?
Utilize 4D-CT scanning, as it can detect missed parathyroid glands.
What is the primary purpose of performing a fine-needle aspiration (FNA) in cases of suspected parathyroid lesions?
To differentiate between parathyroid and thyroid lesions.
What is the purpose of performing selective venous sampling in the evaluation of parathyroid lesions?
To localize the source of excess parathyroid hormone production.
What is the purpose of intraoperative parathyroid hormone (PTH) measurement during parathyroid surgery?
To confirm the removal of the affected parathyroid gland(s).
What is the recommended method for identifying and removing parathyroid glands intraoperatively, according to Norman and colleagues?
Radiation-guided parathyroid gland identification and removal using sestamibi.
What is the most accurate and commonly used study for preoperative localization of parathyroid adenomas?
Technetium-99m sestamibi
Which imaging technique can help identify parathyroid glands located in unusual anatomical positions?
MRI
What technique is particularly helpful for ruling out intrathyroidal parathyroid adenomas?
Ultrasound
What has been found to be more accurate and have a better positive predictive value than sestamibi scans or radiology-performed ultrasounds for preoperative localization?
Neck ultrasound
What causes false positives in localization studies because of uptake in thyroid nodules or lymph nodes?
Technetium-99m sestamibi
Which imaging technique is not helpful for finding mediastinal adenomas?
Ultrasound
What is a limitation of sestamibi when it comes to multigland hyperplasia?
Inadequate localization
MRI and CT are less commonly used as routine preoperative imaging for parathyroid adenomas because:
They have lower specificity compared to sestamibi
Which technique increases the sensitivity of technetium-99m sestamibi for detecting smaller adenomas?
Single-photon emission computed tomography (SPECT)
For reoperative parathyroidectomy, many surgeons favor how many confirming localization procedures before revision surgery?
Two
Learn about primary hyperparathyroidism, its incidence, common demographic characteristics, diagnostic criteria, and the concept of normocalcemic primary hyperparathyroidism. Understand the importance of calcium and PTH levels in the diagnosis of this condition.
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