[15] Hyperparathyroidism

Question 1

What is PTH secreted in response to?

Answer 1

Decreased calcium

Question 2

What is the effect of PTH?

Answer 2

Increased osteoclast activity
Increased calcium and decreased phosphate reabsorption in the kidney
Increased 1alpha-hydroxylation of 25OH-Vit D3

Question 3

What is the presentation of hyperparathyroidism due to?

Answer 3

Increased calcium

Question 4

What are the categories of symptoms of hyperparathyroidism?

Answer 4

Renal
Bone
Psychological 
Abdominal
Other

Question 5

What are the renal symptoms of hyperparathyroidism?

Answer 5

Renal stones
Polyuria and polydipsia
Nephrocalcinosis

Question 6

What causes polyuria and polydipsia in hyperparathyroidism?

Answer 6

Nephrogenic diabetes insipidus

Question 7

What are the bone symptoms of hyperparathyroidism?

Answer 7

Bone pain

Pathological fractures

Question 8

What are the psychological symptoms of hyperparathyroidism?

Answer 8

Depression

Question 9

What are the abdominal symptoms of hyperparathyroidism?

Answer 9

Abdominal pain
Nausea and vomiting
Constipation
Pancreatitis
Peptic ulcer disease

Question 10

What causes peptic ulcer disease in hyperparathyroidism?

Answer 10

Increased gastrin secretion

Question 11

What are the other symptoms of hyperparathyroidism?

Answer 11

Increased BP

Question 12

What are the causes of primary hyperparathyroidism?

Answer 12

Solitary adenoma
Hyperplasia
Parathyroid cancer

Question 13

What % of cases of hyperparathyoidism are caused by a solitary adenoma?

Answer 13

80%

Question 14

What % of cases of hyperparathyroidism are caused by hyperplasia?

Answer 14

20%

Question 15

What % of cases of hyperparathyroidism are caused by parathyroid cancer?

Answer 15

<0.5%

Question 16

What investigations are done in hyperparathyroidism?

Answer 16

Bloods
ECG
X-ray
DEXA

Question 17

What will be found on blood tests in hyperparathyroidism?

Answer 17

High calcium, with high or inappropriately normal PTH
Increased ALP
Decreased phosphate

Question 18

What may be found on ECG in hyperparathyroidism?

Answer 18

Decreased QTc, leading to bradycardia and 1st degree heart block

Question 19

What might be found on hand x-ray in hyperparathyroidism?

Answer 19

Osteitis fibrosa cystica, leading to phalangeal erosions

Question 20

What is the purpose of a DEXA scan in hyperparathyroidism?

Answer 20

Look for osteoporosis

Question 21

What are the general management measures in hyperparathyroidism?

Answer 21

Increase fluid intake
Avoid dietary calcium
Avoid thiazides

Question 22

What is the surgical management of hyperparathyroidism?

Answer 22

Excision

Question 23

What are the risks of excision in hyperparathyroidism?

Answer 23

Development of hypoparathyroidism

Recurrent laryngeal nerve palsy

Question 24

What are the causes of secondary hyperparathyroidism?

Answer 24

Vitamin D deficiency

Chronic renal failure

Question 25

What will be found on blood tests in secondary hyperparathyroidism?

Answer 25

``` Increased PTH Decreased calcium Increased phosphate Increased ALP Decreased vit D ```

Question 26

How is secondary hyperparathyroidism managed?

Answer 26

Correct cause Phosphate binders Vitamin D Cinacalcet

Question 27

Give an example of a phosphate binder with calcium?

Answer 27

Calcichew

Question 28

Give two examples of phosphate binders without calcium

Answer 28

Sevelamer | Lanthanum

Question 29

What does cinacalcet do?

Answer 29

Increase parathyroid calcium sensitivity

Question 30

What causes tertiary hyperparathyroidism?

Answer 30

Prolonged secondary hyperparathyroidism leading to autonomous PTH secretion

Question 31

What will be found on blood tests in tertary hyperparathyroidism?

Answer 31

Increased calcium Increased PTH Decreased phosphate Increased ALP