Hyperparathyroidism

Question 1

What is hyperparathyroidism?

Answer 1

Excess production of PTH- can be due to a tumour

Leads to an increase in calcium

Question 2

How does PTH work?

Answer 2

Acts to increase serum calcium levels
Increases Ca absorption in the kidneys and gut
Increases osteoclastic activity to increase Ca levels
Increases formation of active VitD that acts on the above to increase Ca levels

Question 3

What are the different causes of hyperparathyroidism?

Answer 3

Primary
Secondary
Tertiary

Question 4

What is primary and how is it managed?

Answer 4

Due to excessive PTH secretion as a result of a PTH tumour
Leads to hypercalcaemia

Treatment is with removal of tumour

Question 5

What is secondary and how is it managed?

Answer 5

Due to VitD deficiency or renal impairment
Leads to hypocalcaemia
Results in increase activity of parathyroid glands to stimulate increase in serum calcium
Results in hyperplasia of parathyroid gland

Calcium levels will be normal or low

Treatment is with renal replacement or Vit D supplements

Question 6

What is tertiary and how is it managed?

Answer 6

When secondary has been ongoing for a long period of time and is then treated
There is still hyperplasia of parathyroid gland and so excessive amounts of PTH produced
Leads to hypercalcaemia

Treatment is with removal of some parathyroid glands to make levels normal

Question 7

What are symptoms of hypercalcaemia?

Answer 7

Bone

• bone pain
• pathological fractures
• muscle wasting

Renal

• renal stones
• polyuria
• CKD/AKI

Abdo

• abdo pain
• vomiting
• constipation
• GI ulcers
• pancreatitis

Psych

• depression
• confusion
• tiredness

Question 8

What are causes of hypercalcaemia?

Answer 8

Hyperparathyroidism
Malignancy- myeloma
Renal impairment 
Excess VitD
Excess Ca intake
Genetics- familial hypocalcuric hypercalcaemia
Drugs- thiazides and lithium

Question 9

What investigations are needed in hypercalcaemia?

Answer 9

ECG- shortened QT
Bloods
-PTH= raised
-Ca= raised
-Phosphates= low
-ALP= raised
-U&Es= may show impairment 

24hr urine calcium= raised
Technetium scan for cancer
MRI/USS look for tumour

DEXA scan to assess extent of osteoporosis

Question 10

What is the management of hypercalcaemia?

Answer 10

Find and treat underlying cause

1) IV fluids
- 0.9% saline to lower Ca levels
- 3-6L given over 24 hrs
2) bisphosphonates
- pamidronate single dose
- lowers Ca over 2-3 days
3) calcitonin
- given in life threatening

Monitor osteoporosis
Dialysis for renal patients