Hyerparathyroidism Flashcards

1
Q

define primary hyperparathyroidism?

A

increased secretion of PTH unrelated to the plasma calcium concentration

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2
Q

define secondary hyperparathyroidism?

A

increased secretion of PTH secondary to hypocalcaemia

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3
Q

Define tertiary hyperparathyroidism?

A

autonomous PTH secretion following chronic secondary hyperparathyroidism

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4
Q

what are the causes of primary hyperparathyroidism?

A

Parathyroid adenoma

Parathyroid hyperplasia

Parathyroid carcinoma

MEN syndrome

Associated with HTN

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5
Q

what are the causes of secondary hyperparathyroidism?

A

Chronic renal failure

Malabsorption syndromes

Vitamin D deficiency

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6
Q

summarise the epidemiology of hyperparathyroidism?

A

Primary - incidence of 5/100,000

Twice as common in FEMALES

Peak incidence: 40-60 yrs

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7
Q

what are the risk factors for hyperparathyroidism?

A

female sex

age ≥50-60 years

family history of PHPT

multiple endocrine neoplasia (MEN) 1, 2A, or 4

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8
Q

what are the signs and symptoms of primary hyperparathyroidism?

A

REMEMBER STONES, BONES, ABDO GROANS, PSYCHIC MOANS

Polyuria

Polydipsia

Renal calculi

Bone pain

Sleep disturbances

Memory loss

Abdominal pain

Nausea

Constipation

Psychological depression + anxiety

Lethargy

Fatigue

Memory loss

Myalgia

Paraesthesia

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9
Q

what are the symptoms of secondary hyperparathyroidism?

A

signs and symptoms of hypocalacaemia or signs or uderlying cause ( renal failure, vit D deficiency)

Bruising

Pruritus

Elevated BP

Fatgiue

Nausea

Poor concentration/memory

Tingling in fingers and toes

Myoclonus

Muscle cramps

Bone pain

Chvostek’s sign

Trousseau’s sign

Bowed legs/ knock knees

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10
Q

what are the appropriate investigations for hyperparathyroidism?

A

U&Es – urea and creatinine high in CKD

Serum calcium (high in h and tertiary, low/normal in secondary)

Serum phosphate (low in primary and tertiary and Osteomalacia due to VitD, high in osteomalacia due to CKD)

Albumin

ALP

Vitamin D

PTH

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11
Q

what can be seen on the x ray in hyperparathyroidism?

A
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12
Q

what scans may you order in hyperparathyroidism and what may you see on the scan?

A

x ray

renal ultrasound- visualise renal calculi

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13
Q

outline the management for primary hyperparathyroidism?

A

Acute Hypercalcaemia

  • IV fluids
    • bisphosphonates if calcium remains high
  • Avoid factors that exacerbate hypercalcaemia (e.g. thiazide diuretics)
  • Maintain adequate hydration
  • Moderate calcium and vitamin D intake

Surgical Management

  • Subtotal parathyroidectomy
  • Total parathyroidectomy
  • NEED VIT D SUPPLEMENTATION AFTER

If surgery denied or not suitable

  • Serum calcium and creatinine should be measured every 12 months
  • Avoid meds which increase serum calcium levels (e.g. thiazide diuretics, lithium)
  • Bisphosphonates if osteoporosis is present
  • Vit D supplementation if neccesary
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14
Q

outlind the management for secondary hyperparathyroidism?

A

Treat underlying cause (e.g. renal failure)

  • Gut Phophate binders e.g. Sevelamer – treats the hyperphosphataemia

Calcium and vitamin D supplements may be needed – only after phosphate levels are lowered

e.g. ergocalciferol

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15
Q

what are the possible complications of primary hyperparathyroidism?

A

Increased bone resorption => osteoporosis, bone fractures

Increased tubular calcium reabsorption

Increased 1a-hydroxylation of vitamin D

All of these lead to hypercalcaemia

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16
Q

What are the possible complications of secondary hyperparathyroidism?

A

Increased stimulation of osteoclasts and increased bone turnover => This leads to osteitis fibrosa cystica

Uraemia due to long-term chronic renal failure

17
Q

what are the complications of surgery?

A

Hypocalcaemia

Recurrent laryngeal nerve palsy

18
Q

summarise the prognosis of patients with hyperparathyroidism?

A

Primary - surgery is curative for benign disease in most cases

Secondary or Tertiary - same prognosis as chronic renal failure