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CASE 2

CASE 2. Cantankerous Professor . This 50 year old professor of Medicine has recently become quite cantankerous with his students for the past year or so.

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CASE 2

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  1. CASE 2 Cantankerous Professor

  2. This 50 year old professor of Medicine has recently become quite cantankerous with his students for the past year or so. • He complains of pain in his back, legs, and hands but has no clinical evidence of inflammatory arthritis, such as heat and redness are not evident.

  3. His physical exam revealed the following: • Middle aged gentleman with erratic behavior, tenderness on index finger Rt and Lft hands • Augmented peristalsis. • His laboratory studies are summarized: • Hemoglobin 14.7 g% • Hematocrit 48% • WBC 7430 nl diff. • Serum calcium 13 mg/dL (Nl 10.5) • PTH elevated to 3 SI units (Nl =1) • Urine Nl. • Alkaline Phosphatase 7 (nl 1-4 B units) • Thyroid scan Nl. • Hand X-ray shows bony resorption of distal phalange of index finger.

  4. Hypoparathyroidism • Hyperparathyroidism • Renal hyperparathyroidism

  5. The diagnosis is unlikely because the other glands were normal in size. (Hypo) • This diagnosis cannot be ruled out from the gross but given the history one would think otherwise (Lymphoma)

  6. Hyperparathyroidism • You got the right answer! • Your patient went to surgery and the following tumor was found where one of the parathyroids should have been the others were unremarkable:

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