normal PTH / high calcium

RE: normal PTH / high calcium

Rob Davis — Fri, 19 Feb 2016 18:04:15 GMT

[quote user="John Flynn"]'ve previously thought best to start on oral VitD3/Calcium couple of days pre-surgery and then wean off over few months rather than go cold-turkey and risk labour-intensive interventions.[/quote]

Perhaps I was a bit gung-ho then in my one case - kept dog in for 24 hours, Ca++ middle of normal range 24 hours post op, has remained there ever since.

Would you not be concerned about worsening the existing hypercalcaemia by starting intervention pre-op? I know that Vitamin D takes a few days to kick (depending which preparation you are using), but I would have thought it would be difficult to judge correctly.

RE: normal PTH / high calcium

John Flynn — Thu, 18 Feb 2016 21:05:25 GMT

[quote user="robloxley"]I suspect they included intensive treatment for a postoperative hypocalcaemia due to transient low PTH levels postop due to the other glands down-regulating [/quote]

I've previously thought best to start on oral VitD3/Calcium couple of days pre-surgery and then wean off over few months rather than go cold-turkey and risk labour-intensive interventions.

RE: normal PTH / high calcium

Rob Loxley — Thu, 18 Feb 2016 21:00:35 GMT

[quote user="Rob Davis"]Is it a particularly difficult PTH mass? I have only done one of these, but was no more difficult than a feline thyroidectomy, so would not expect costs to be huge![/quote]

It was referred after diagnosis for removal but the estimated costs were in the thousands - I suspect they included intensive treatment for a postoperative hypocalcaemia due to transient low PTH levels postop due to the other glands down-regulating - and the client declined on cost.

RE: normal PTH / high calcium

Rob Davis — Thu, 18 Feb 2016 15:15:05 GMT

[quote user="robloxley"]I have one client's dog with a confirmed (blds and scan) PTH mass that the referral centre estimated more than the insurance limit to operate on; has been on alendronic acid (cheap as) since and doing very well. Obviously n=1[/quote]

Is it a particularly difficult PTH mass? I have only done one of these, but was no more difficult than a feline thyroidectomy, so would not expect costs to be huge!

RE: normal PTH / high calcium

Rob Loxley — Wed, 17 Feb 2016 20:05:42 GMT

[quote user="Rob Davis"]

[quote user="robloxley"]Can't you manage the hypercalcaemia with bisphosphonates?[/quote]

I have done this once - very expensive, but reduced calcium level very well. Sadly the patient was euthanased with metastatic disease after only a couple of months.

[/quote]

I have one client's dog with a confirmed (blds and scan) PTH mass that the referral centre estimated more than the insurance limit to operate on; has been on alendronic acid (cheap as) since and doing very well. Obviously n=1

RE: normal PTH / high calcium

Rob Davis — Wed, 17 Feb 2016 16:26:19 GMT

[quote user="robloxley"]Can't you manage the hypercalcaemia with bisphosphonates?[/quote]

I have done this once - very expensive, but reduced calcium level very well. Sadly the patient was euthanased with metastatic disease after only a couple of months.

RE: normal PTH / high calcium

gareth — Tue, 16 Feb 2016 21:44:53 GMT

likely elevated PTHrP...common with this type of tumour...and esp in spaniel (Cocker??) type breeds

RE: normal PTH / high calcium

Andrew Kent — Tue, 16 Feb 2016 18:42:06 GMT

[quote user="robloxley"]

[quote user="Andrew Kent"]But its likely this dog needs surgery ultimately[/quote]

Can't you manage the hypercalcaemia with bisphosphonates?

[/quote]

Sometimes, and I know of a few cases in which that has been employed successfully, but also some cases that have proved difficult to control.

But in the long run it works out more expensive than a curative surgery.

Andy

RE: normal PTH / high calcium

Rob Loxley — Tue, 16 Feb 2016 18:28:12 GMT

[quote user="Andrew Kent"]But its likely this dog needs surgery ultimately[/quote]

Can't you manage the hypercalcaemia with bisphosphonates?

RE: normal PTH / high calcium

Andrew Kent — Tue, 16 Feb 2016 16:19:08 GMT

Interesting... may well be more than one mechanism involved I guess.

Andy

RE: normal PTH / high calcium

Beats — Tue, 16 Feb 2016 12:43:48 GMT

Thanks for help. For follow-up, examined today and had presumed anal sac neoplasm on rectal with palpably large presumed LN involvement. Presume that is cause of hypercalcemia and just treating palliatively with steroids.

RE: normal PTH / high calcium

Andrew Kent — Sat, 13 Feb 2016 09:20:42 GMT

Sometimes they are more obvious than you might expect so definitely worth a look!

But its likely this dog needs surgery ultimately - is that going to be financially feasible for the owners?

Andy

RE: normal PTH / high calcium

Beats — Fri, 12 Feb 2016 19:59:17 GMT

Hi Andy,

Thanks for that!

I'm not sure my ultrasound skills are up to it, but will have a go when I next see the dog.

Dave

RE: normal PTH / high calcium

Andrew Kent — Fri, 12 Feb 2016 19:53:19 GMT

Hi Dave,

even though the PTH is normal it is still inappropriate for the severity of hypercalcaemia so I would think primary hyperparathyroidism is most likely.

I would ultrasound the neck and see what you find.

Andy