Hyperparathyroidism

Question 1

What is th presentation of PHPT?

Answer 1

Asymptomatic hypercalcaemia

Question 2

Where are most PHPT patients diagnosed?

Answer 2

In the outpatient clinic on routine blood tests

Question 3

What is the work up for PHPT?

Answer 3

Elevated Ca –> assess PTH –> if greatly elevated = PHPT

Question 4

What is normocalcaemia hyperparathyroidism?

Answer 4

Elevated PTH by no changes in Ca

Question 5

Ddx for hypercalcaemia

Answer 5

Malignancy
Hamilial Hypocalciuric Hypercalcaemia
Drugs

Question 6

What type of calcium is assessed?

Answer 6

Ionied calcium

Question 7

Is urinary calcium obtained for PHPT?

Answer 7

No

Question 8

Describe the male:female and age of PHPT?

Answer 8

Female: male = 4:1, mostly of adults

Question 9

What are th 3 main aetiologies of PHPT?

Answer 9

Adenomas (80%)
Hyperplasia (5-10%)
Parathyroid carcinoma

Question 10

What are the key genetic defects in PHPT?

Answer 10

Cycin D1 (a regulator of cel cycle)
MEN1 mutations (form part of multiple endurance neoplasia 1 and 2)

Question 11

What is the defect observed in FHH?

Answer 11

Defect of CASR

Question 12

what is the crux of PHPT?

Answer 12

PTH is inappropriately elevated for the Ca concentration

Question 13

Describe the GI disturbances of PHPT

Answer 13

Constipation, nausea, pancreatitis, gallstones

Question 14

What psychic moans are present?

Answer 14

Depression, lethargy ad seizures

Question 15

How do we classify the causes of Secondary hpyerparathryoidism?

Answer 15

Conditions of losing calcium (renal failure)

Conditions of lacking ingested calcium (vit D deficiency)

Question 16

Why does secondary hypercaclaemi arise?

Answer 16

Chronic hypcalcaemai leads to compensation by the parathyroid glands

Question 17

How does chronic renal failure lead to hypercalcaemia?

Answer 17

CKD –> reduced phosphate excretion –> yperphosphatateaemia –> binds to Calcium –> hypocalcaemia -=> stimulates the parathyroid gland t produce PTH
(plus redced 1-alpha-hydroxylase–> reduce Vitamin D)

Question 18

What is the biggest threat in sever hypercalcaemia?

Answer 18

Dehydration, electrolyte deplete and kidney injury

Question 19

How do you rehydrate someone with severe hypercaclaemia?

Answer 19

NaCL 0.9% 4-6L, IV and then monitor via Cardiac function and volume overload

Question 20

How do you treat volume overload when rehydrating someone?

Answer 20

IV frusemide

Question 21

How do you prevent further Ca increase in sever ehypercalcaemia?

Answer 21

IV bisphosphonates (Zolendronic acid or pamidronate)

Question 22

What are the contraindication for bisphosphonates

Answer 22

Renal impairment (give salmon calcitonin instead)

Question 23

How do yo treat hypecalcaemia from granulomatous disease?

Answer 23

Prednisolone 15-30mg oral

Question 24

What granulomatous diseases can cause hypercalcamia?

Answer 24

Tb, amyloidosis, sarcoidosis

Question 25

What are our targets in hypercalcaemia treatment?

Answer 25

Increase urinary ca excretion
Diminish bone resopriton
Decrease GI Ca absorption

Question 26

How will we increase urinary ca excretion?

Answer 26

Isotonic slaine +/- loop diureic

Calcitonin

Question 27

How will we diminish bone resopriton

Answer 27

Bsiphosphonates

Question 28

How will we decrease GI Ca absorption?

Answer 28

Corticoseroids in hyervitaminsosi D and malginancy