Hyperparathyroidism

Question 1

What are the different types of hyper-PTH?

Answer 1

Primary = from parathyroid tumour

Secondary = raised PTH in response to low calcium

• renal failure
• vitamin D deficiency

Tertiary = prolonged secondary hyper-PTH results in autonomous excessive production of PTH resulting in hypercalcaemia

Question 2

What is the pathology of parathyroid tumours?

Answer 2

Solitary parathyroid adenoma = 85%
Parathyroid hyperplasia = 15%
Carcinoma = <1%

Question 3

What are the symptoms of hyper-PTH?

Answer 3

Asymptomatic >50%

Calcium -bone, stones, abdo groans, psychic moans

Secondary hyper-PTH
-Eventually develop osteitis fibrosa, cystica, soft tissue calcifications

Tertiary hyper-PTH
-Pancreatitis,metastatic calcification

Question 4

How does the hormonal profile (blood investigations) differ between the three types of hyper-PTH?

Answer 4

PRIMARY
>PTH = ++
>Calcium = ++
>Phosphate = --
>Serum Calcium : Creatinine clearance ratio > 0.01

SECONDARY
>PTH = ++
>Calcium = normal or --
>Phosphate = ++
>Vitamin D = --

TERTIARY
>PTH = ++
>Calcium = ++
>Phosphatase = normal or --
>Vitamin D = normal or --
>ALP = raised

Question 5

What scan is used to locate tumours?

Answer 5

Sestamibi nuclear scan used to identify position of adenoma

Question 6

How is hyper-PTH treated?

Answer 6

All = high fluid intake to prevent stones

Primary = surgical resection
Secondary = treat underlying cause

Question 7

What is primary hyperparathyroidism associated with?

Answer 7

Hypertension

Multiple endocrine neoplasia (MEN I and II)