Hyperparathyroidism

Question 1

Which cells in the parathyroid gland secrete hormones?

Answer 1

Chief cells produce parathyroid hormone

Question 2

What is the action of PTH?

Answer 2

Acts to raise blood calcium
- Increase osteoclast activity
- Increase calcium absorption from the gut and kidneys
- Increase vitamin D activity

Question 3

What is the action of vitamin D?

Answer 3

Increases calcium absorption from the intestines

Question 4

What are the symptoms of hypercalcaemia?

Answer 4

Renal stones
Painful bones
Abdominal groans (constipation, nausea, vomiting)
Psychiatric moans (fatigue, depression, psychosis)

Question 5

What is primary hyperparathyroidism?

Answer 5

Tumour of parathyroid glands causing increased PTH and hypercalcaemia

Question 6

What is secondary hyperparathyroidism?

Answer 6

Insufficient vitamin D or chronic renal failure leads to low calcium absorption causing hypocalcaemia.
Parathyroid glands react to low calcium by excreting more PTH causing hyperplasia
Calcium levels remain low but PTH levels are high

Question 7

What is tertiary hyperparathyroidism?

Answer 7

Secondary hyperparathyroidism continues for a long period of time causing hyperplasia
Baseline levels of PTH increase dramatically
Leads to hypercalcaemia

Question 8

What are the 3 conditions associated with MEN 1?

Answer 8

Primary hyperparathyroidism
Pancreatic tumour
Pituitary adenoma

Question 9

What are the 3 conditions associated with MEN 2a?

Answer 9

Primary hyperparathyroidism
Medullary thyroid carcinoma
Pheochromocytoma

Question 10

What is the management of hypercalcaemia?

Answer 10

Rehydration
IV bisphosphates
Glucocorticoids
Surgical tumour removal
Parathyroidectomy
Correct vitamin D deficiency