Endocrinology 10 - Hyperparathyroidism

Question 1

5 effects of parathyroid hormone

Answer 1

increasing osteoclast activity
increasing gut calcium absorption
increasing kidney calcium absorption and phosphate excretion
increasing vit D activity

Question 2

effect of activated vitamin D

Answer 2

need working kidney and liver to activate

increases gut calcium absorption

Question 3

primary hyperparathyroidism

Answer 3

parathyroid tumour secreting excess PTH

high PTH, high calcium

needs surgical removal

Question 4

secondary hyperparathyroidism

Answer 4

insufficient vitamin D or chronic renal failure

high PTH, low/normal calcium

correct vit D or fix kidneys

Question 5

tertiary hyperparathyroidism

Answer 5

prolonged secondary hyperparathyroid leads to elevation of PTH baseline

thus on treatment of ‘secondary’, calcium levels become too high

need surgery to remove some of the hyperplasia

Question 6

2 main causes of Conn’s / primary hyperald

Answer 6

adrenal adenoma
bilateral adrenal hyperplasia

aldosterone high, renin low

Question 7

secondary hyperaldosteronism

Answer 7

renal artery stenosis
heart failure
renal artery obstruction

high renin as kidney BP low, high aldosterone as a result

Question 8

how is renal artery stenosis confirmed?

Answer 8

doppler ultrasound or angiogram

if cause of high aldosterone RAS, then do a CT/MRI for adrenal tumours

Question 9

investigation of choice with suspected hyperaldosteronism

give 3 other important tests to build the picture

Answer 9

renin-aldosterone ratio

blood pressure
serum electrolytes
blood gas

(HTN, low potassium, high sodium, alkalosis)

Question 10

management of renal artery stenosis

Answer 10

percutaneous renal artery angioplasty

Question 11

treatment of hyperaldosteronism

Answer 11

eplerenone or spironolactone

remember that it’s the most common cause of secondary HTN