Hyperparathyroidism

Question 1

What is primary hyperparathyroidism

Answer 1

excess secretion of PTH resulting in hypercalcaemia

Question 2

What are causes of primary hyperparathyroidism

Answer 2

85%-solitary adenoma
10%-hyperplasia
4%-multiple adenoma
1% - carcinoma

Question 3

What is secondary hyperparathyroidism and what are some causes

Answer 3

increased secretion of PTH in response to hypocalcemia

-chronic renal failure
-vitamin D deficiency

Question 4

What is tertiary hyperparathyroidism

Answer 4

autonomous PTH secretion following secondary hyperparathyroidism

Question 5

What may a patient with hyperparathyroidism present with

Answer 5

around 80% are asymptomatic

-primary presents with hypercalcaemia
bones, stones, abdominal groans and psychic moans

-polydipsia, depression,anorexia,bone pain, hypertension

Question 6

How could secondary hyperparathyroidism present

Answer 6

with hypocalcemia
paresthesia, muscle spasms, cramps and seizures

Question 7

What investigations are required

Answer 7

Bloods
- primary : high PTH, high calcium , low phosphate

-secondary : high PTH, low/normal calcium ,high phosphate, low vitamin D

-tertiary : high PTH, normal/high calcium, low/normal phosphate , high ALP

Technetium mibi subtraction scan - makes detection of small parathyroid glands easier to locate

Question 8

What are some x ray findings one can see in hyperparathyroidism

Answer 8

pepperpot skull - multiple tiny well defined lucencies in the calvaria caused by resorption of trabecular bone in hyperparathyroidism

osteitis fibrosa cystica= classical bone disease - includes subperiosteal resorption , distal tapering of clavicles

Question 9

What is the epidemiology of hyperparathyroidism

Answer 9

most common in women aged 50-60

Question 10

What is the management for primary hyperparathyroidism

Answer 10

definitive management is total parathyroidectomy

Question 11

When is conservative management offered to patients with primary hyperparathyroidism

Answer 11

conservative offered if calcium <0.25mmol/L above upper limit AND patient is >50 AND no evidence of organ damage

Question 12

What are patients with primary hyperparathyroidism who are not suitable for surgery offered

Answer 12

CINACALCET- mimics action of calcium on tissues

Question 13

How is secondary hyperparathyroidism treated

Answer 13

medical therapy

indications for surgery include - bone pain, persistent pruritus and soft tissue calcifications

Question 14

How is tertiary hyperparathyroidism treated

Answer 14

excise gland/ total parathyroidectomy