Hyperparathyroidism

Question 1

1) What cells in the parathyroid glands produce parathyroid hormone?
2) What do these cells produce parathyroid hormone in response to?
3) Name 2 effects the parathyroid hormone has in response to this

Answer 1

1) Chief cells
2) Hypocalcaemia
3) Increase: osteoclast activity in bones (reabsorbing calcium from bones), calcium absorption from the gut, calcium absorption from the kidneys, vitamin D activity

Question 2

Name 2 symptoms of hyperparathyroidism

Answer 2

• Renal stones
• Painful bones
• Constipation, nausea and vomiting
• Fatigue, depression and psychosis

Question 3

1) What normally causes primary hyperparathyroidism?
2) How is it treated?
3) How is it treated in patients unsuitable for the above management?

Answer 3

1) Uncontrolled parathyroid hormone produced directly by a tumour of the parathyroid glands (solitary parathyroid adenoma = commonest)
2) Surgical removal of tumour
3) Cinacalcet - calcium mimetic to decrease activity of the hormone

Question 4

1) Name a cause of secondary hyperparathyroidism?
2) How does this cause secondary hyperparathyroidism?
3) How can it be treated?

Answer 4

1) CKD, vitD deficiency
2) These lead to low absorption of calcium from the intestines, kidneys and bones. This causes hypocalcemia and subsequent hyperparathyroidism
3) Treat the cause of hypocalcemia

Question 5

1) What causes tertiary hyperparathyroidism, and what will this subsequently lead to?
2) How can this be treated?

Answer 5

1) When secondary hyperparathyroidism continues for a long period of time and leads to hyperplasia of the glands. Even if the cause of hypocalcemia is removed, excessive parathyroid hormone will still be produced leading to hypercalcaemia
2) Removal of a part of the parathyroid gland