[15] Hyperparathyroidism Flashcards
What is PTH secreted in response to?
Decreased calcium
What is the effect of PTH?
Increased osteoclast activity
Increased calcium and decreased phosphate reabsorption in the kidney
Increased 1alpha-hydroxylation of 25OH-Vit D3
What is the presentation of hyperparathyroidism due to?
Increased calcium
What are the categories of symptoms of hyperparathyroidism?
Renal Bone Psychological Abdominal Other
What are the renal symptoms of hyperparathyroidism?
Renal stones
Polyuria and polydipsia
Nephrocalcinosis
What causes polyuria and polydipsia in hyperparathyroidism?
Nephrogenic diabetes insipidus
What are the bone symptoms of hyperparathyroidism?
Bone pain
Pathological fractures
What are the psychological symptoms of hyperparathyroidism?
Depression
What are the abdominal symptoms of hyperparathyroidism?
Abdominal pain Nausea and vomiting Constipation Pancreatitis Peptic ulcer disease
What causes peptic ulcer disease in hyperparathyroidism?
Increased gastrin secretion
What are the other symptoms of hyperparathyroidism?
Increased BP
What are the causes of primary hyperparathyroidism?
Solitary adenoma
Hyperplasia
Parathyroid cancer
What % of cases of hyperparathyoidism are caused by a solitary adenoma?
80%
What % of cases of hyperparathyroidism are caused by hyperplasia?
20%
What % of cases of hyperparathyroidism are caused by parathyroid cancer?
<0.5%
What investigations are done in hyperparathyroidism?
Bloods
ECG
X-ray
DEXA
What will be found on blood tests in hyperparathyroidism?
High calcium, with high or inappropriately normal PTH
Increased ALP
Decreased phosphate
What may be found on ECG in hyperparathyroidism?
Decreased QTc, leading to bradycardia and 1st degree heart block
What might be found on hand x-ray in hyperparathyroidism?
Osteitis fibrosa cystica, leading to phalangeal erosions
What is the purpose of a DEXA scan in hyperparathyroidism?
Look for osteoporosis
What are the general management measures in hyperparathyroidism?
Increase fluid intake
Avoid dietary calcium
Avoid thiazides
What is the surgical management of hyperparathyroidism?
Excision
What are the risks of excision in hyperparathyroidism?
Development of hypoparathyroidism
Recurrent laryngeal nerve palsy
What are the causes of secondary hyperparathyroidism?
Vitamin D deficiency
Chronic renal failure
What will be found on blood tests in secondary hyperparathyroidism?
Increased PTH Decreased calcium Increased phosphate Increased ALP Decreased vit D
How is secondary hyperparathyroidism managed?
Correct cause
Phosphate binders
Vitamin D
Cinacalcet
Give an example of a phosphate binder with calcium?
Calcichew
Give two examples of phosphate binders without calcium
Sevelamer
Lanthanum
What does cinacalcet do?
Increase parathyroid calcium sensitivity
What causes tertiary hyperparathyroidism?
Prolonged secondary hyperparathyroidism leading to autonomous PTH secretion
What will be found on blood tests in tertary hyperparathyroidism?
Increased calcium
Increased PTH
Decreased phosphate
Increased ALP
