(!) Hyperparathyroidism

Question 1

Define Hyperparathyroidism

Answer 1

Endocrine disorder characterised by excessive PTH secretion
can be primary-linked to the PTH gland -often parathyroid adenoma
Or secondary-where a disease causing low Calcium leads to normal, physiological high PTH-often CKD, Via D deficiency
Or tertiary-where chronically low Ca leads to autonomous PTH production, even when Ca is normal

Question 2

Aetiology and risk factors of Hyperparathyroidism

Answer 2

Primary-innapropriate PTH secretion
85%-parathyroid adenoma
10%-MEN related multiple endocrine disorders

Secondary-anything that causes low calcium
Malabsorption-Crohns, coeliac
Increased use-Pregnancy, Bisphosphnates, loop diuretics
and VIT D def and
CKD (most common)

Tertiary-usually after chronic secondary

Risk factors:
Primary-
Female, age 50-60
FHx of Primary HPTH

Secondary-
ageing
CKD
VIT D def
malabsorption issues (coeliac, crohns)

Question 3

Epidiemology of Hyperparathyroidism

Answer 3

Primary-
relatively common-1 in 500 female, 1 in 2000 men

Secondary–common associated to CKD and VIT D def
And those are VERY common conditions

Question 4

Signs and Sx of Hyperparathyroidism

Answer 4

Secondary-High PTH but NORMAL/Low calcium
Signs of hypocalceamia--cramps
parasthesia
Chvostek and trousseaus sign
Osteomalacia signs (bowed legs)

Features of renal failure (pruritus, bruising, fluid overload)
and feature of malabsorption

PRIMARY/Tertiary-high PTH and HIGH calcium
Very common-kidney stones

Bone pain, poor sleep, fatigue, anxiety. depression, memory loss

Muscle weakness and parashesia
Muscle cramps, consipation

Bones (pain), stones (kidney), Groans (Cholic abdominal pain) and Psychic Moans

Question 5

Investigations of Hyperparathyroidism

Answer 5

PTH levels-HIGH in all cases

Primary
Calcium HIGH/highnormal
Phosphate-Low

Secondary-
Calcium LOW, 
PTH High
Creatinine/urea can be high due toCKD
Vit D levels-can be low, but also in primary and tertiary
Phosphate-up or down

Tertiary
PTH very high
Calcium-norm or high
Phosphate-raised (big difference with primary

Question 6

Management of Hyperparathyroidism

Answer 6

Primary-surgical approach for anyone symptomatic or asympto but with surgical indication (age>50, able to follow up, etc)
Parathyroidectomies

asymtpo, can’t surgery-close monitoring

Secondary–
VIT D supplements for anyone that need it
Malabsorption related-treat disease (control Crohns, don’t eat gluten coeliac)

CKD-
control Phosphate with Phos binders
Generally reduce calcium diet and phosph diet
Dyalisis
Kidney transplant

Question 7

Complications of Hyperparathyroidism

Answer 7

Primary-Lots of surgical complications--laryngeal nerve injury
Osteoporosis
Bone fractures
Kidney stones
if Ca way too high-coma and death

Secondary
Lack of vitD-osteodystrophy/porosis
Renal transplant can lead to tertiary HPTH

Question 8

Prognosis of Hyperparathyroidism

Answer 8

Primary
asymptomatic with no surgery-75% stable over 10 years
Surgery has 99% success rate

Secondary-mirrors underlying disease
Much easier in Vit D related and malabsorption

In CKD-renal transplant is the best way in the end (which can cause tertiary HPTH)