Hyperparathyroidism Flashcards
Understanding the causes and effects of hyperparathryodism
What is th presentation of PHPT?
Asymptomatic hypercalcaemia
Where are most PHPT patients diagnosed?
In the outpatient clinic on routine blood tests
What is the work up for PHPT?
Elevated Ca –> assess PTH –> if greatly elevated = PHPT
What is normocalcaemia hyperparathyroidism?
Elevated PTH by no changes in Ca
Ddx for hypercalcaemia
Malignancy
Hamilial Hypocalciuric Hypercalcaemia
Drugs
What type of calcium is assessed?
Ionied calcium
Is urinary calcium obtained for PHPT?
No
Describe the male:female and age of PHPT?
Female: male = 4:1, mostly of adults
What are th 3 main aetiologies of PHPT?
Adenomas (80%)
Hyperplasia (5-10%)
Parathyroid carcinoma
What are the key genetic defects in PHPT?
Cycin D1 (a regulator of cel cycle) MEN1 mutations (form part of multiple endurance neoplasia 1 and 2)
What is the defect observed in FHH?
Defect of CASR
what is the crux of PHPT?
PTH is inappropriately elevated for the Ca concentration
Describe the GI disturbances of PHPT
Constipation, nausea, pancreatitis, gallstones
What psychic moans are present?
Depression, lethargy ad seizures
How do we classify the causes of Secondary hpyerparathryoidism?
Conditions of losing calcium (renal failure)
Conditions of lacking ingested calcium (vit D deficiency)
Why does secondary hypercaclaemi arise?
Chronic hypcalcaemai leads to compensation by the parathyroid glands
How does chronic renal failure lead to hypercalcaemia?
CKD –> reduced phosphate excretion –> yperphosphatateaemia –> binds to Calcium –> hypocalcaemia -=> stimulates the parathyroid gland t produce PTH
(plus redced 1-alpha-hydroxylase–> reduce Vitamin D)
What is the biggest threat in sever hypercalcaemia?
Dehydration, electrolyte deplete and kidney injury
How do you rehydrate someone with severe hypercaclaemia?
NaCL 0.9% 4-6L, IV and then monitor via Cardiac function and volume overload
How do you treat volume overload when rehydrating someone?
IV frusemide
How do you prevent further Ca increase in sever ehypercalcaemia?
IV bisphosphonates (Zolendronic acid or pamidronate)
What are the contraindication for bisphosphonates
Renal impairment (give salmon calcitonin instead)
How do yo treat hypecalcaemia from granulomatous disease?
Prednisolone 15-30mg oral
What granulomatous diseases can cause hypercalcamia?
Tb, amyloidosis, sarcoidosis
What are our targets in hypercalcaemia treatment?
Increase urinary ca excretion
Diminish bone resopriton
Decrease GI Ca absorption
How will we increase urinary ca excretion?
Isotonic slaine +/- loop diureic
Calcitonin
How will we diminish bone resopriton
Bsiphosphonates
How will we decrease GI Ca absorption?
Corticoseroids in hyervitaminsosi D and malginancy
