Hyperparathyroidism Flashcards
what is it
increased secretion of parathyroid hormone
leading to hypercalcaemia and hypophosphataemia
what is the function of PTH in bones, kidney and GI tract
stimulates the release of calcium from bones which in turn contributes to the resorption of bones (breakdown of bones- trust)- via osteoclasts
also stimulates the changing of osteoblasts into osteoclasts
increases calcium reabsorption in the kidneys (PCT and LofH)
decreases phosphate reabsorption in the PCT
activates vitamin D which also helps absorb more calcium from food
what causes PTH secretion
low calcium levels
who gets hyperpararthyroidism
women 3:1 men
what are the 3 types of hyperparathyroidism
Type 1= parathyroid adenoma
Type 2= parathyroid hyperplasia usually in response to CKD (it causes hypocalcaemia)
Type 3= persistent parathyroid hyperplasia i.e prolonged type 2
i.e type 1= primary type 2= secondary type 3= prolonged type 2
what are risk factors for developing hyperparathyroidism
radiation therapy to neck
severe vit d/ Ca deficiency
familial conditions e.g. MEN1&2A
How does hyperparathyroidism present
Stones, bones, moans and groans
kidney stones
osteoporosis (low Ca in the bones)
depression and anxiety
myalgia (muscle pain)/ fatigue
how do you investigate hyperparathyroidism
DEXA scan (X-ray for bone density)
PTH blood test
bone profile
renal function/ CT kidney
how would you interpret a blood test for PTH, serum calcium and serum phosphate to diagnose the types of hyperparathyroidism
Type 1 (primary)= PTH= high or normal Serum calcium= high Serum phosphate= low
Type 2 (secondary)= PTH= high Serum calcium= low or nomral serum phosphate= high or low
Type 3 (tertiary)= PTH= very high Serum calcium= high Serum phosphate= high
How do you manage primary hyperparathyroidism
parathyroidectomy and calcimimetics e.g. cincalcet
bisphosphonates to improve bone strength
How do you manage secondary hyperparathyroidism
Vit D and calcium supplements
Kidney transplant if CKD
calcimimetics e.g. Cinacalcet
How do you manage tertiary hyperparathyroidism
parathyroidectomy
calcimimetics e.g. Cinacalcet
