Hyperparathyroidism

Question 1

what is hyperparathyroidism

Answer 1

excess prod of PTH from parathyroid gland

Question 2

describe the causes of the 3 types of hyperparathyroidism

Answer 2

primary:
- due to parathyroid gland itself
- parathyroid adenoma/carcinoma
- parathyroid hyperplasia
- drug induced e.g. lithium

secondary:

• stimulus is low Ca2+
• kidney disease e.g. CKD
• vit D (1,25-dihydroxycholecalciferol) deficiency

tertiary:
- prolonged secondary hyperparathyroidism –> hyperplasia

Question 3

what is the most common cause of primary hyperparathyroidism

Answer 3

parathyroid adenoma (80% cases)

Question 4

what are the regulators of parathyroid hormone

Answer 4

• low Ca2+
• high phosphate
• low Mg2+

Question 5

what is the name of the active form of vitamin D

Answer 5

1,25-dihydroxycholecalciferol

or calcitriol

Question 6

describe the presentation of a Px w/ hyperparathyroidism

Answer 6

bones, moans, groans, and stones

bones - bone pain, osteoporosis
moans - fatigue, depression, CNS disturbance, muscle weakness
groans - GI disturbance, abdominal pain, operatic ulcer
stones - kidney stones

Question 7

what investigation can be done in suspected hyperparathyroidism

Answer 7

• check serum calcium, PTH, phosphate (and alkaline phosphate)
• DEXA scan (may show osteopenia), urine calcium

ensure other causes of hypercalcaemia excluded before considering diagnosis of hyperparathyroidism, e.g. thiazide diuretics which are calcium sparing

Question 8

describe the results of serum tests that would be seen in primary/secondary/tertiary hyperparathyroidism

Answer 8

primary:
- ⬆️ PTH
- ⬆️ serum calcium
- ⬇️ serum phosphate

secondary:

• ⬆️ PTH
• ⬇️ serum calcium
• ⬆️ serum phosphate

tertiary:

• ⬆️ PTH
• ⬆️ serum calcium
• ⬇️ serum phosphate

(ALP raised for all)

Question 9

outline management of hyperparathyroidism

Answer 9

primary:

• increase oral fluids, monitor PTH
• biphosphonates –> prevent/reduce osteoporosis

secondary:
- treat cause
- diet low in phosphates, high in calcium
- calcimimetics e.g. cinacalcet

parathyroidectomy is definitive

Question 10

what are some secondary symptoms as a result of hyperparathyroidism

Answer 10

• osteomalacia
• rickets
• renal osteodystrophy

Question 11

what are some complications of hyperparathyroidism

Answer 11

• renal calculi
• acute pancreatitis
• peptic ulceration
• calcification of cornea