Hyperparathyroidism

Question 1

What are the three types and their causes?

Answer 1

1 - Primary: adenoma

2 - Secondary: PT gland hyperplasia due to LOW Ca in CRF, or low vitamin D

3 - Tertiary: Ongoing hyperplasia of all 4 PT glands after correction of underlying disease

Question 2

What are the SX of primary?

Answer 2

Bones, stones, abdo groans and psychic moans

Bone pain
Renal stones
PUD/ constipation/ pancreatitis
Depression

Other: polydipsia, polyuria, HTN

Question 3

What blood tests results will you see for primary?

Answer 3

High PTH
High Ca
Low PO4

Question 4

What might you see on a skull XR in primary?

Answer 4

Pepperpot skull

Question 5

What is the definitive mx for primary?

Answer 5

Total parathyroidectomy

Question 6

When is conservative mx offered in primary and what is it?

Answer 6

When Ca level is <0.25 mmol/L above the limit of normal AND pt is >50 AND no evidence of end-organ damage

If mild: advise increased fluid intake
to prevent stones; avoid thiazides + high Ca2+ & vit D intake; see
6-monthly

Question 7

What are the SX of secondary?

Answer 7

ASX

Bone disease, soft tissue calcifications

Question 8

What is the blood profile of secondary?

Answer 8

High PTH
Low Ca
High PO4
Low vit D

Question 9

How is secondary mx?

Answer 9

Rx cause

e.g. Rx CRF or give vit D supplements

Question 10

What are the SX of tertiary?

Answer 10

Metastatic calcification
Bone pain/ fracture
Nephrolithiasis
Pancreatitis

Question 11

What does the the tertiary blood profile look like?

Answer 11

High PTH
Normal/high Ca
Low/normal PO4
Low/normal vit D

Question 12

How do you mx tertiary?

Answer 12

Total parathyroidectomy and re-implantation

Question 13

Where is PTH secreted from?

Answer 13

Parathyroid gland

Question 14

What are the roles of PTH?

Answer 14

Increase absorption of Ca into blood from gut, kidneys and bones

Question 15

What is the role of Vit. D?

Answer 15

Helps Ca absorption

Question 16

What does phosphate do?

Answer 16

Phosphorylation, ATP, part of DNA + RNA

Question 17

What effects does high PTH have on Ca and PO4?

Answer 17

Increases Ca

Decreases PO4 as it is excreted in urine

Question 18

What causes release of PTH from PT gland?

Answer 18

Low calcium levels

Question 19

What is released when Ca levels are too high and from where?

Answer 19

Calcitonin

From thyroid gland

Question 20

What are the ECG changes associated with hyperCa?

Answer 20

Short QT

Question 21

What are the ECG changes associated with hypoCa?

Answer 21

Long QT

Question 22

What aCa level requires emergency MX?

What is the MX?

Answer 22

> 3.0 mmol/L

ECG
IV fluids: SALINE 4-6l in 24h
Look for cause
Consider: IV Zoledronate, steroids (lymphoma, granulomatous disease)