Chief Complaint: 37-year-old female complaining of acute pain over her right flank and persistent abdominal pain.
History: A 37-year-old female presents to her physician’s office with acute pain over her right flank and persistent abdominal pain. Additionally, she reports a 2-year history of generalized fatigue and depression associated with difficulty concentrating and significant mood swings. She has no history of drug or alcohol use and no significant family history. Following ultrasound examination, she is diagnosed with a kidney stone. Laboratory tests of serum parathyroid levels reveal an abnormally high parathyroid hormone concentration of 125 pg/mL. The patient is further diagnosed with hyperparathyroidism and it is determined that exploratory surgery is needed. Once the parathyroid glands have been exposed they are visually and physically examined. On palpation a small mass is found on the right inferior parathyroid gland and removed. Parathryoid hormone levels were monitored until returning to normal limits.
Given what is known about the function of the parathyroid gland what is another substance in the blood serum that you would expect to be outside of normal limits? Why?
What are the upstream regulators of parathyroid function? In other words, what is the normal flow of information to either stimulate or suppress parathyroid function?
What are the downstream effectors that the parathyroid hormone acts on? How does this explain the symptoms our patient presented with?
Propose a possible treatment for the patient in this case study. How does this treatment improve conditions for the patient? Are these improvements seen at the cellular, tissue, organ or systemic level?
Relate this case to the general homeostatic mechanism pathway – identify the setpoint, variables, receptor(s), effector(s), and integrating center in this specific case.

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