Sunday, May 25, 2014

Increased Parathyroid Gland Activity is seldom Investigated for Stone in Urinary Tract

Increased parathyroid gland activity (hyperparathyriodism) is seldom, if ever, consciously investigated for stone in urinary Tract e.g. Kidney stones (Nephrolithiasis), Ureteric stone (Usually forms and descends down from kidney) and stone in urinary bladder.
"Bone, Stone, Abdominal Groan and Psychiatric Moan"

Symptoms and signs of hyperparathyroidism can be described in the classical and helpful mnemonic, "painful bones, renal stones, abdominal groans, and psychic moans."
A very simple blood test i.e. serum calcium level will give some clue, if there is excess parathyroid activity; be it benign or malignant disease of the gland. Other investigations, then may confirm the disease. The normal serum calcium level is in the range from 8.5 to 10.2 mg/dL. But, there are age-wise variations, which are most important for clinicians to interpret the results. Laboratory does not give age specific value for serum calcium. Age specific calcium level is as below: according to the e-journal Medscape.

  • Younger than 12 months: Not established
  • Age 1-14 years: 9.6-10.6 mg/dL
  • Age 15-16 years: 9.5-10.5 mg/dL
  • Age 17-18 years: 9.5-10.4 mg/dL
  • Age 19-21 years: 9.3-10.3 mg/dL
  • Age 22 years and older: 8.9-10.1 mg/dL
  • Younger than 12 months: Not established
  • Age 1-11 years: 9.6-10.6 mg/dL
  • Age 12-14 years: 9.5-10.4 mg/dL
  • Age 15-18 years: 9.1-10.3 mg/dL
  • Age 19 years and older: 8.9-10.1 mg/dL
Still, several factors like acidosis and alkalosis, those influence the serum level of calcium, including collection of blood sample using a tourniquet. Serum calcium > 1 mg/dL above upper limit of normal is one of the criteria for diagnosis of hyperparathyroidism.
Therefore, in all patients with renal stones, serum calcium level is to be estimated. Enhanced by Zemanta


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