Hyperparathyroidism Flashcards

1
Q

Definition (primary)

A

Primary Hyperparathyroidism - increased secretion of PTH unrelated to the plasma calcium concentration

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2
Q

Definition (secondary)

A

Secondary Hyperparathyroidism - increased secretion of PTH secondary to hypocalcaemia

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3
Q

Definition (tertiary)

A

Tertiary Hyperparathyroidism - autonomous PTH secretion following chronic secondary hyperparathyroidism

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4
Q

Aetiology/Risk factors (primary)

A

o Parathyroid adenoma
o Parathyroid hyperplasia
o Parathyroid carcinoma
o MEN syndrome

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5
Q

Aetiology/Risk factors (secondary)

A

o Chronic renal failure

o Vitamin D deficiency

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6
Q

Presenting symptoms and signs on physical examination (primary)

A

· Primary - many patients have mild hypercalcaemia and may be asymptomatic

· Symptoms/Signs of hyperclacaemia:
o Polyuria
o Polydipsia
o Renal calculi
o Bone pain/Osteoporosis
o Abdominal pain
o Nausea
o Constipation
o Psychological depression
o Lethargy
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7
Q

Presenting symptoms and signs on physical examination (secondary)

A

· Secondary - may present with signs/symptoms of HYPOcalcaemia or of the underlying cause (e.g. renal failure, vitamin D deficiency)

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8
Q

Investigations

A

· U&Es

· Serum calcium (high in primary and tertiary, low/normal in secondary)
· Serum phosphate (low in primary and tertiary, high in secondary)
· Albumin (elevated)
· ALP
· Vitamin D
· PTH

· Primary Hyperparathyroidism
o Hyperchloraemic acidosis
o Normal anion gap
o Due to PTH inhibition of renal reabsorption of bicarbonate
o Urine - high PTH in the presence of high calcium can also be caused by familial hypocalciuric hypercalcaemia (FHH)
· Calcium: creatinine clearance ratio can help differentiate between primary hyperparathyroidism and FHH

· Renal ultrasound - can visualise renal calculi

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9
Q

Management plan (acute hypercalcaemia)

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

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10
Q

Management plan (surgical)

A

o Subtotal parathyroidectomy

o Total parathyroidectomy

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11
Q

Management plan (secondary)

A

o Treat underlying cause (e.g. renal failure)

o Calcium and vitamin D supplements may be needed

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12
Q

Possible complications (primary)

A

o Increased bone resorption

o Increased tubular calcium reabsorption

o Increased 1a-hydroxylation of vitamin D

o All of these lead to hypercalcaemia

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13
Q

Possible complications (secondary)

A

o Increased stimulation of osteoclasts and increased bone turnover

o This leads to osteitis fibrosa cystica

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14
Q

Possible complications (surgery)

A

o Hypocalcaemia

o Recurrent laryngeal nerve palsy

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15
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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