Interdisciplinary cohesion in managing a case of parathyroid adenoma – A case report

Abstract

Introduction: Interdisciplinary cohesion is indispensable in patient management. Exchange of scientific information between the various specialties of medicine paves the way forward to productive patient outcomes. We share an example of interdisciplinary cohesion in the management of a patient with parathyroid adenoma. Parathyroid adenoma is a benign neoplasm derived from parathyroid parenchymal cells. The parathyroid glands play a key role in calcium homeostasis. Parathyroid adenomas are responsible for hyperparathyroidism in 30 to 90 % of the cases [1]. Hyperparathyroidism can present with a multitude of symptoms. Some as innocuous as generalized weakness & some which may involve pain such as renal stones. Even psychiatric manifestations have been described in hyperparathyroidism. Hence a patient with hyperparathyroidism could seek the help of the various specialists in medicine ranging from endocrinologists to urologists. Cohesion, exchange of ideas & a patient centric approach is essential in management of such cases. The old adage ‘too many cooks spoil the broth’ is a reminder that conflict & exertion of superiority of one branch to another will not augur good for the patient. Our case report is an illustration of how teamwork and an interdisciplinary approach between different branches of medicine will stand the patient in good stead [2].

Case presentation: A 74-year-old man presented to the surgeon with nephrolithiasis, weakness & fatigue. An endocrinologist’s opinion was sought. It came to light through radionuclide scan & parathormone (PTH) testing that the patient harboured a parathyroid adenoma. A diagnosis of primary hyperparathyroidism was established. The surgeon had planned for left lower parathyoidectomy in his hospital & testing for intraoperative PTH levels. A drop in the IOPTH > 50 % is considered as successful excision of the parathyroid glands [3,4,5]. However, the hospital laboratory did not have the facility to test of intraoperative PTH levels. The clinical team came in touch with the laboratory team of Apollo diagnostics. The reference laboratory of Apollo diagnostics was situated 20 km away from the location where the surgery was to take place. However, with meticulous planning & exchange of ideas, it was decided that the surgery be performed in the early hours of a Sunday morning. The early hours of Sunday were chosen to avoid the brunt of the city’s traffic. The base line as well as IOPTH samples were transported to the testing facility by ambulance within an hours’ time & the samples were tested after all the pre-requisites for sample testing such as QC checks were passed. The results were satisfactory as the drop in PTH level was > 50 % The excised glands were subjected to histopathological study & the diagnosis of parathyroid adenoma was confirmed.

Conclusion: Interdisciplinary participation in patient management is vital towards positive patient outcomes. Rapport & discussion between the various disciplines in medicine as well as the culture of ‘putting the patient first’ resulted in a positive outcome & successful management of the patient.