Hyperparathyroidism

Question 1

What are common causes of hyperparathyroidism

Answer 1

Adenomas and carcinomas: increasing PTH secretion
Malignant disease: causing humoral increase in parathyroid hormone related peptide
Can be asymptomatic

Question 2

What is the difference between primary, secondary, and tertiary hyperparathyroidism

Answer 2

Primary: Parathyroid adenoma
Secondary: CKD causing hyperphosphatemia and decreased vitamin D
Tertiary: Parathyroid hyperplasia

Question 3

Who is most commonly affected by parathyroid tumors and are they more often benign?

Answer 3

CKD and Lithium therapy patient
Benign
Usually glandular

Question 4

What is different about a parathyroid carcinoma

Answer 4

Rare
Typically results in very high calcium levels 14-15

Question 5

S/s of hyperparathyroidism

Answer 5

Recurrent nephrolithiasis, peptic ulcers, mental changes, bone reabsorption

Question 6

Describe the renal affects of hyperparathyroidism

Answer 6

Recurrent nephrolithiasis
Typically stones are made of calcium
Can causes recurrent stones, UTI, obstruction, and AKI

Question 7

Describe the bone manifestations of hyperparathyroidism

Answer 7

Osteoporosis, pathologic fractures, increased fibrotic tissues,

Question 8

Neurological effects of hyperparathyroidism

Answer 8

CNS dysfunction
Muscle weakness, fatigue, atrophy

Question 9

Cardiovascular symptoms of hyperparathyroidism

Answer 9

HTN, LVH, prolonged PR, shortened QT, Bradycardia, asystole, heart blocks

Question 10

What are the PTH and ionized calcium levels in primary hyperparathyroidism

Answer 10

PTH: >91
Ionized calcium: high
urine calcium: >100

Question 11

What are the PTH and ionized calcium levels in secondary hyperparathyroidism

Answer 11

PTH: >91
Ionized calcium: normal to high

Question 12

What are the PTH and ionized calcium levels in non-parathyroid hypercalcemia

Answer 12

PTH: <31
Ionized calcium: high

Question 13

If a serum calcium:phosphate ratio is >2.5 what is suspected

Answer 13

Primary hyperparathyroidism

Question 14

If a serum calcium is >14 what do we expect

Answer 14

Parathyroid carcinoma

Question 15

All hyperparathyroidism patient regardless of symptoms should be monitored for what?

Answer 15

Albumin, phosphate, calcium, PTH, renal function, and BP

Question 16

Bone density scans should be preformed how often in hyperparathyroidism patients

Answer 16

Every 2 years

Question 17

What are lifestyle modifications for hyperparathyroidism patients

Answer 17

Increase water intake, decrease prolonged immobilization

Question 18

What should be given to Postmenopausal HPT patients

Answer 18

Estrogen supplement

Question 19

What medication can be given to combat hypercalciuria

Answer 19

HCTZ

Question 20

When is genetic testing recommended for HPT

Answer 20

Primary HPT < 40yrs old
Multiglandular disease
Family Hx of HPT

Question 21

What medications can be administered in HPT to combat elevated calcium

Answer 21

IVF
Cinacalcet: CaSR activator
Pamidromate: IV biphosphonate; temporary tx
Oral biphosphonates: not effective in HPT hypercalcemia but can be given with cinacalcet to decrease osteoporosis
Denosumab: can be given for severe cases d/t carcinoma can cause infections
Vitamin D supplementation
Calcitrol: given after HD to suppress parathyroid hyperplasias

Question 22

What are surgical options for HPT

Answer 22

Parathyroidectomy for symptomatic
Surgical resection of carcinoma