Hyperparathyroidism Flashcards
What are common causes of hyperparathyroidism
Adenomas and carcinomas: increasing PTH secretion
Malignant disease: causing humoral increase in parathyroid hormone related peptide
Can be asymptomatic
What is the difference between primary, secondary, and tertiary hyperparathyroidism
Primary: Parathyroid adenoma
Secondary: CKD causing hyperphosphatemia and decreased vitamin D
Tertiary: Parathyroid hyperplasia
Who is most commonly affected by parathyroid tumors and are they more often benign?
CKD and Lithium therapy patient
Benign
Usually glandular
What is different about a parathyroid carcinoma
Rare
Typically results in very high calcium levels 14-15
S/s of hyperparathyroidism
Recurrent nephrolithiasis, peptic ulcers, mental changes, bone reabsorption
Describe the renal affects of hyperparathyroidism
Recurrent nephrolithiasis
Typically stones are made of calcium
Can causes recurrent stones, UTI, obstruction, and AKI
Describe the bone manifestations of hyperparathyroidism
Osteoporosis, pathologic fractures, increased fibrotic tissues,
Neurological effects of hyperparathyroidism
CNS dysfunction
Muscle weakness, fatigue, atrophy
Cardiovascular symptoms of hyperparathyroidism
HTN, LVH, prolonged PR, shortened QT, Bradycardia, asystole, heart blocks
What are the PTH and ionized calcium levels in primary hyperparathyroidism
PTH: >91
Ionized calcium: high
urine calcium: >100
What are the PTH and ionized calcium levels in secondary hyperparathyroidism
PTH: >91
Ionized calcium: normal to high
What are the PTH and ionized calcium levels in non-parathyroid hypercalcemia
PTH: <31
Ionized calcium: high
If a serum calcium:phosphate ratio is >2.5 what is suspected
Primary hyperparathyroidism
If a serum calcium is >14 what do we expect
Parathyroid carcinoma
All hyperparathyroidism patient regardless of symptoms should be monitored for what?
Albumin, phosphate, calcium, PTH, renal function, and BP
Bone density scans should be preformed how often in hyperparathyroidism patients
Every 2 years
What are lifestyle modifications for hyperparathyroidism patients
Increase water intake, decrease prolonged immobilization
What should be given to Postmenopausal HPT patients
Estrogen supplement
What medication can be given to combat hypercalciuria
HCTZ
When is genetic testing recommended for HPT
Primary HPT < 40yrs old
Multiglandular disease
Family Hx of HPT
What medications can be administered in HPT to combat elevated calcium
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
What are surgical options for HPT
Parathyroidectomy for symptomatic
Surgical resection of carcinoma
