Hyperparathyroidism Flashcards

1
Q

Define primary:

A

increased secretion of PTH unrelated to the plasma calcium concentration

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2
Q

Define secondary:

A
  • increased secretion of PTH secondary to hypocalcaemia
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3
Q

Define tertiary:

A

autonomous PTH secretion (despite high calcium) following chronic secondary hyperparathyroidism – glands undergo hyperplastic or adenomatous changes.

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4
Q

Aetiology/risk factors of primary:

A

o Parathyroid adenoma 80%
o Parathyroid hyperplasia 20%
o Parathyroid carcinoma <0.5%
o MEN syndrome

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5
Q

Aetiology/risk factors of secondary:

A

o Chronic renal failure

o Vitamin D deficiency – causes reduced calcium absorption in gut hence hypocalcaemia

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6
Q

Epidemiology:

A
  • Primary - incidence of 5/100,000
  • Twice as common in FEMALES
  • Peak incidence: 40-60 yrs
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7
Q

Symptoms/signs of primary:

A
•	Primary - many patients have mild hypercalcaemia and may be asymptomatic 
•	Symptoms/Signs of hypercalcaemia:
o	Polyuria
o	Polydipsia
o	Renal calculi 
o	Bone pain 
o	Abdominal pain 
o	Nausea
o	Constipation 
o	Psychological depression 
o	Lethargy 
o	Pancreatitis
o	Duodenal ulcers
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8
Q

Symptoms/signs of secondary:

A

CATS go numb:

Convulsions
Arrhythmias
Tetany
Paraesthesia in hands, mouth, feet and lips
Chvostek’s sign (tap facial nerve just below zygomatic arch and see twitching) and trousseau’s sign (inflation of BP cuff for several minutes induces carpopedal spasm)

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9
Q

Investigations:

A
•	U&amp;Es
•	Serum calcium (high in primary and tertiary, low/normal in secondary)
•	Serum phosphate (low in primary and tertiary, high in secondary)
•	Albumin
•	ALP
•	Vitamin D 
•	PTH - high
•	Primary Hyperparathyroidism
o	Hyperchloraemic acidosis 

• Renal ultrasound - can visualise renal calculi

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10
Q

Management:

A

o IV fluids
o Avoid factors that exacerbate hypercalcaemia (e.g. thiazide diuretics)
o Maintain adequate hydration
o Moderate calcium and vitamin D intake

Surgical Management
o Subtotal parathyroidectomy
o Total parathyroidectomy

Secondary Hyperparathyroidism Management
o Treat underlying cause (e.g. renal failure)
o Calcium and vitamin D supplements may be needed

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11
Q

Complications of primary:

A

o Increased bone resorption
o Increased tubular calcium reabsorption
o Increased 1-hydroxylation of vitamin D
o All of these lead to hypercalcaemia

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12
Q

Complications of secondary:

A

o Increased stimulation of osteoclasts and increased bone turnover
o This leads to osteitis fibrosa cystica – seen on X-ray as subperiosteal erosions, cysts, brown tumours, pepper pot skull

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13
Q

Complications of surgery:

A

o Hypocalcaemia
o HypoPTH
o Recurrent laryngeal nerve palsy

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14
Q

Prognosis:

A
  • Primary - surgery is curative for benign disease in most cases
  • Secondary or Tertiary - same prognosis as chronic renal failure
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