Hyperparathyroidism

Question 1

What is it?

Answer 1

Hyperparathyroidism involves overactivity of the parathyroid glands with high levels of parathyroid hormone (PTH).

Question 2

Primary

Answer 2

Primary hyperparathyroidism is due to a benign adenoma, hyperplasia or rarely a malignant neoplasia. Overproduction of PTH results in hypercalcaemia with subsequent symptoms and signs (fatigue, depression, bone pain, myalgia, nausea, thirst, polyuria, renal stones, osteoporosis). Serum PTH is usually elevated and calcium is high. Phosphate is normal or low.

Question 3

Secondary

Answer 3

Secondary hyperparathyroidism is a physiological overproduction of PTH secondary to hypocalcaemia usually caused by vitamin D deficiency or CKD.

Question 4

Tertiary

Answer 4

Tertiary hyperparathyroidism is seen in patients with chronic secondary hyperparathyroidism (usually CKD) who develop an adenoma which will continue to produce PTH despite biochemical correction.

Question 5

treatment

Answer 5

removal of the adenomatous gland or treatment of the underlying cause (vitamin D supplementation). Very high serum calcium levels need emergency treatment (iv fluids, bisphosphonates, calcitonin).