13. Hyperparathyroidism

Question 1

the secretion and synetjsisi of parathyroid hormone is controlled by what ?

Answer 1

1) CALCUM CONSCENTRATION (calcium 2plus )

and calcium concentration is detected by the calcium sensing receptor

2) calciferol concentrator = inversely associated with parathyroid hormone secretion
high calciferol = low PTH

3) phosphate = stimulating effect of PTH
4) FGF = suppressive effect

Question 2

what is the definition of primary hyperparathyroidism ?

Answer 2

hypercalcemia

elevated or inappropriately NORMAL conc of PTH

Question 3

what is the aetiology of primary hyperparathyroidism ?

Answer 3

single parathyroid adenoma

hyperplasia of ALL four glands and multiple adenoma

rarely parathyroid carcinoma

familial
MULTIPLE ENDOCRINE NEOPLASIA = MEN1
MEN2A

Question 4

primary hyperparathyroidism is classified into that

Answer 4

symptomatic and and asymptomatic

Question 5

what are the signs and symptoms in symptomatic hyperparathyroidism ?

Answer 5

Cardiovascular disease
acute - bradycardia
chronic - hypertension ,shorter QT interval and left ventricular hypertrophy

Kidney
Nephrolithiasis, nephrocalcinosis
Polyuria,
polydipsia

Musculoskeletal system
Bone, muscle, and joint pain
fractures

Digestive tract
acute : vomitting

chronic :weight loss
constipation
PUD
pancreatitis

Psychological symptoms: depression, anxiety, sleep disorders
confusion and coma

Question 6

how can we diagnose primary hyperparathyroidism

Answer 6

diagnosis = xray
osteitis fibrosa cystica = salt and pepper degranulation of skull
bone cysts
bone tumors !!

bone densitomerty = distal third radius = sensitive site for hyperparathyroidism

tapering of distal clavicle

elevated pth or inapportely normal
with elevated calcium

calciuria for 24 hr

hypophosphatemia

25 oh vit D = normal or low 
--------
for adenoma 
US = for adenoma 
technetium 99 sestamibi scanning with single photon CT 
dynamic CT imaging 

renal US = stones
—-

Question 7

what is the diagnosis of hyperparathyroidism ?

Answer 7

elevated pth or inapportely normal

with elevated calcium

Question 8

what is secondary hyperparathyroidism ?

Answer 8

REACTIVE PARATHYROID HORMONE INCREASE

↓ calcium and/or ↑

phosphate blood levels → reactive hyperplasia of the parathyroid glands → ↑ PTH secretion

due to

Chronic kidney disease → impaired renal phosphate excretion → ↑ phosphate blood levels→ ↑ PTH secretion

In addition, CKD →
↓ biosynthesis of active vitamin D → decreased calcium resorption → ↑ PTH secretion

Question 9

what is tertiary hyperparathyroidism ?

Answer 9

autonomous secretion of PTH because of long standing secondary hyerparathryosism

= SEEN IN END STAGE RENAL DISEASE

there is very high pth (more than that of primary and secondary ) and high calcium and phosphorous level variable depending on kidney function

Question 10

what is familial hypocalciuric hypercalcemia ?

Answer 10

low calcium excretion in the urine and hypercalcemia , duet mutation in CaSR gene

Question 11

what is the acute managemnet of hyperparthyroidism ?

Answer 11

HYPERCALCEMIA WHICH IS LIFE THREATENING

1) SALINE HYDRATION
2) INHIBITION OF BONE RESORPTION = BISPHOSOPNATE , CALCITONIN
3) LOOP DIURETICS = FUROSEMIDE
4) cinacalcet

Question 12

WHAT IS THE management of primary hyperparathyroidism ?

and secondary ?

Answer 12

parathyroid surgery

cinacalcet = binds to calcium sensing receptor and reductes PTH

osteoporosis- bisphosphante/ calcitonin

=======

treat the chronic kidney condition

then hyperphosphotemia
dietary pophorous restriction
phosphate bndes - calcum carbonate

vit d déficient - ergocalciferol