International Journal of Clinical Case Reports, 2016, Vol.6, No.26, 1-4
3
lobectomy. The postoperative course was uneventful. A month after the cervicotomy, the patient was
asymptomatic and the laboratory tests became normal (calcemia=95mg/ml and PTH=39pg/ml).
3 Discussion
The first parathyroidectomy was performed by Vienna Mandle in 1925. The PHPT is one of the main causes of
hypercalcemia in non-hospitalized patients and its prevalence is 0.5% to 16.7% (Charopoulas et al., 2006). In the
series of Clark and al, the majority of the patients with a PHPT were symptomatic with bone and muscle pain,
polydipsia, polyuria, asthenia, anorexia, constipation, pruritus and other complications such as urinary stones in
20%, osteopenia, hypertension and heart disease (Clark and Duh., 1989). The diagnosis of PHPT is confirmed by
the association of hypercalcemia, hypophosphatemia and inadequate high PTH in the absence of hypocalciuria.
The topographic diagnosis uses the ultrasound technics, imaging by nuclear magnetic resonance, but can only rely
on irradiating examinations such as sestamibi scintigraphy (Butler .,and al., 2000). In our case, the parathyroid
adenoma was easily detected on scan because of its large size. The radical treatment is an effective way to
establish normocalcemia. In 10-15%, the hypercalciuria may persist despite the treatment which reflects an
underlying idiopathic hypercalciuria that must be systematically tested in the lithias ic patients away from the
parathyroidectomy (Van Heerden and Grant., 1991). Currently, the surgical treatment of coralliform
nephrolithiasis with the bivalve nephrotomy is abandoned at the cost of PCNL monotherapy or in combination
with extracorporeal lithotripsy or flexible ureteroscopy using several sources of fragmentation, laser or ultrasonic
waves. This innovative technic showed satisfactory results in terms of stone-free rate (Saussinea., and
Lechevallierb., 2008). The lithiasic metabolic balance is a real etiological investigation to determine the nature
and the origin of the calculi and many authors insisted for it in case of recurrent or bilateral episodes (Simon., and
al 2015). The initial tests are based on the calculi morphoconstitutional study recovered with a standard blood and
urine laboratory tests (Table 1). In case of multiple stones, bilateral or recurrent, nephrocalcinosis, in c hildren, a
solitary kidney, renal failure, a second line exploration in a specialized environment is mandatory, (Table 2),
(Traxerb O., and al., 2008).
Table 1 : First line tests
24h-urines from Saturday to Sunday night
Blood
Monday morning
Urinary awakening (Monday
morning)
Creatinine
Calcemia
Uric acid
Urea
Sodium
Volume
Creatinine
Calcemia
Uric acid
Fast Glycemia
Density
pH by pHmetry
Cristalluria
Urinary
dipstick testing
and or
urine antibiogram
Table 2 : Second line tests
Blood tests
24H-urine tests
Serum electrolytes
total proteins
phosphoremia
intact PTH
Oxaluria
Citraturia
Magnesuria
Proteinuria
Phosphaturia
Glycosuria
Dynamic tests
PAK test
Urine acidification test
