hyperparathyroidism Flashcards
define primary hyperparathyroidism?
increased secretion of PTH unrelated to the plasma calcium concentration
define secondary hyperparathyroidism?
increased secretion of PTH secondary to hypocalcaemia
define tertiary hyperparathyroidism?
autonomous PTH secretion following chronic secondary hyperparathyroidism
most common cause of primary hyperparathyroidism?
Parathyroid adenoma
what might cause secondary hyperparathyroidism?
o Chronic renal failure
o Vitamin D deficiency
what is the epidemiology of primary hyperparathyroidism?
- common in females
- classically an elderly female
what are the presenting symptoms and signs of primary hyperparathyroidism?
• Bones, stones, abdominal groans and psychic groans o Polyuria o Polydipsia o Renal calculi o Bone pain o Abdominal pain o Nausea o Constipation o Psychological depression o Lethargy
how might secondary hyperparathyroidism present?
signs/symptoms of HYPOcalcaemia
what are the investigations for hyperparathyroidism?
- U&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 (raised or might be inappropriately normal)
what might the radiology show for hyperparathyroidism?
- Renal ultrasound - can visualise renal calculi
- X-ray – pepper-pot skull
- Osteopenia
management plan for acute hyperparathyroidism?
o IV fluids
o Avoid factors that exacerbate hypercalcaemia
o Maintain adequate hydration
o Moderate calcium and vitamin D intake
how can hyperparathyroidism be surgically managed?
o Subtotal parathyroidectomy
o Total parathyroidectomy - GOLD STANDARD
how can hyperparathyroidism be medically managed?
o If the calcium levels are below 0.25mmol/L above the upper limit
o And the patient is less than 50 and there’s no evidence of end organ damage
o Can use calcimimetic agents
how to treat secondary hyperparathyroidism?
o Treat underlying cause (e.g. renal failure)
o Calcium and vitamin D supplements may be needed
complications of hyperparathyroidism?
• Primary
o Increased bone resorption
o Increased tubular calcium reabsorption
o Increased 1-hydroxylation of vitamin D
o All of these lead to hypercalcaemia
• Secondary
o Increased stimulation of osteoclasts and increased bone turnover
o This leads to osteitis fibrosa cystica
