seminar 08-12-2007 - casus i dr sleeboom
TRANSCRIPT
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*1*
Casus I
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*2*
vrouw 40 jaar (1996)
marsfractuur
fanatiek hardloopster
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*3*
amenorrhoea sedert 4 jaar
1994 ook marsfractuur
verder blanco anamnese
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*4*
lengte 168 cm
gewicht 46 kg
R/ Didrokit
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*5*
Laboratoriumonderzoek:
oestradiol sterk verlaagd
Vit. D nog niet bekend
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*6*
DXA : L.2 – L.4 T -3,6
Femur totaal T -1,6
X-LSWK : osteoporose
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*7*
welk advies
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*8*
Oestrogenen
Calcium
Vitamine D
Stop Didrokit
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*9*
weggebleven
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*10*
2004 : opname neurologie
trekkingen
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*11*
lichamelijk onderzoek overigens
niet afwijkend
R/ Alendroninezuur
Pantoprazol
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*12*
Serumcalcium 1,67 mmol/l
Albumine 38 gr/l
Magnesium 0,41 mmol/l
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*13*
PTH 2,8 pmol/l
25 OH vit.D3 45 nmol/l
R/ calciumsuppletie + vitamine D
en later ook magnesiumsuppletie
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*14*
gastroscopie, colonoscopie,
duodenografie en biopten
waren normaal
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*15*
geconsulteerde internist
begreep er niets van
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*16*
ik ook niet
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*17*
maar sedert 27 oktober 2006 wel
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*18*
welke diagnose
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*19*
N E J M oktober 26, 2006
Proton-Pump Inhibitors and
Hypomagnesemic Hypoparathyroidism
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*20*
de patiënte onttrok zich
aan de controles
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*21*
juli 2007: anafylactische reactie
op wespensteek
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*22*
nooit eerder gehad
R/ alendroninezuur
calcium
magnesium
pantoprazol
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*23*
laboratorium: normaal
serumcalcium, magnesium,
TSH, PTH, cortisol en
25 OH vit.D3
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*24*
DXA: L2 – L4 T – 3,4
Femur totaal T – 1,8
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*25*
welk verder onderzoek
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*26*
serumtryptase
methylhistamine in urine
beenmergbiopsie
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*27*
indolente vorm van
systemische mastocytose
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*28*
R/ calcium + vitamine D
alendroninezuur
pantoprazol en magnesium gestopt