Hyperparathyroidism

Question 1

What is hyperparathyroidism?

Answer 1

Hyperparathyroidism is a condition characterised by excessive secretion of parathyroid hormone (PTH), leading to hypercalcaemia and related symptoms.

Question 2

What are the three types of hyperparathyroidism?

Answer 2

Primary, secondary, and tertiary hyperparathyroidism.

Question 3

What is the cause of primary hyperparathyroidism?

Answer 3

It is caused by a hyperfunctioning parathyroid gland, typically due to a solitary adenoma, hyperplasia, or, rarely, parathyroid carcinoma.

Question 4

What causes secondary hyperparathyroidism?

Answer 4

It occurs due to chronic hypocalcaemia, often secondary to vitamin D deficiency or chronic kidney disease.

Question 5

What is tertiary hyperparathyroidism?

Answer 5

It occurs after prolonged secondary hyperparathyroidism, where parathyroid glands become autonomous, secreting excessive PTH despite normal calcium levels.

Question 6

What are the main symptoms of hyperparathyroidism?

Answer 6

Fatigue, weakness, bone pain, depression, constipation, kidney stones, and polyuria.

Question 7

What are the “bones, stones, abdominal groans, and psychic moans”?

Answer 7

A mnemonic for the symptoms of hyperparathyroidism: bone pain, kidney stones, abdominal discomfort, and psychological disturbances like depression.

Question 8

What is the role of PTH in calcium regulation?

Answer 8

PTH increases calcium levels by promoting bone resorption, increasing calcium absorption in the gut (via vitamin D), and reducing renal calcium excretion.

Question 9

What is the pathophysiology of primary hyperparathyroidism?

Answer 9

Excess PTH secretion leads to increased calcium release from bones, enhanced calcium absorption in the gut, and decreased renal calcium excretion.

Question 10

How does chronic kidney disease lead to secondary hyperparathyroidism?

Answer 10

Reduced renal function decreases vitamin D activation and calcium reabsorption, leading to hypocalcaemia and compensatory PTH secretion.

Question 11

What are the key biochemical findings in primary hyperparathyroidism?

Answer 11

Elevated calcium, low or normal phosphate, and raised PTH levels.

Question 12

What are the biochemical findings in secondary hyperparathyroidism?

Answer 12

Low or normal calcium, high phosphate (in chronic kidney disease), and elevated PTH levels.

Question 13

What investigations are used to diagnose hyperparathyroidism?

Answer 13

Serum calcium, phosphate, PTH levels, vitamin D levels, and renal function tests. Imaging may include ultrasound or sestamibi scan of the parathyroid glands.

Question 14

What is the role of a sestamibi scan in hyperparathyroidism?

Answer 14

A sestamibi scan identifies hyperfunctioning parathyroid glands, particularly in primary hyperparathyroidism.

Question 15

What is the main differential diagnosis for hyperparathyroidism?

Answer 15

Hypercalcaemia due to malignancy, vitamin D toxicity, sarcoidosis, or medications like thiazides.

Question 16

How is primary hyperparathyroidism managed?

Answer 16

Definitive management involves surgical removal of the affected parathyroid gland(s).

Question 17

What are the indications for parathyroidectomy in primary hyperparathyroidism?

Answer 17

Symptomatic hypercalcaemia, complications (e.g., fractures, kidney stones), or very high calcium levels.

Question 18

How is secondary hyperparathyroidism managed?

Answer 18

Treat the underlying cause, such as correcting vitamin D deficiency, phosphate binders, or active vitamin D analogues in chronic kidney disease.

Question 19

What is the treatment for tertiary hyperparathyroidism?

Answer 19

Parathyroidectomy is typically required, as the glands are autonomous and unresponsive to medical management.

Question 20

What are the complications of untreated hyperparathyroidism?

Answer 20

Osteoporosis, fractures, kidney stones, nephrocalcinosis, and cardiovascular complications such as hypertension.

Question 21

What lifestyle advice is given to patients with hyperparathyroidism?

Answer 21

Adequate hydration, avoiding excessive calcium or vitamin D intake, and regular monitoring of bone health and kidney function.

Question 22

How does hyperparathyroidism affect bone density?

Answer 22

Increased PTH levels cause bone resorption, leading to reduced bone density and increased fracture risk.

Question 23

What is the role of bisphosphonates in hyperparathyroidism management?

Answer 23

Bisphosphonates may be used to manage osteoporosis by reducing bone resorption in patients with hyperparathyroidism.

Question 24

How does hyperparathyroidism cause kidney stones?

Answer 24

Hypercalcaemia increases calcium excretion in urine, predisposing to stone formation.

Question 25

What are the clinical signs of hypercalcaemia?

Answer 25

Dehydration, polyuria, constipation, confusion, arrhythmias, and muscle weakness.