Hyperparathyroidism Flashcards

1
Q

Define Hyperparathyroidism

A

Excess of parathyroid hormone (PTH) release

Primary: Autonomous overproduction of PTH which results in derangement of calcium metabolism

Secondary: elevation of PTH levels as a response to hypocalcaemia

Tertiary: Autonomous PTH secretion following chronic secondary hyperparathyroidism

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2
Q

Aetiology of Primary Hyperparathyroidism

A

Inappropriate PTH secretion -> hypercalcaemia

Parathyroid adenoma (85%)
Multiple adenoma and gland hyeprtrophy 
MEN-1, MEN-2, HPTH-jaw tumour syndrome 
Lithium 
<1% parathyroid malignancy
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3
Q

Aetiology of Secondary Hyperparathyroidism

A

Hypocalcaemia -> appropriate PTH elevation

Chronic Kidney Disease (loss of 1-alpha hydroxylase)
Malbsorption (Crohn’s, Coeliac, Chronic pancreatitis, gastric bypass)
Inadequate sunlight exposure (vit D deficiency)
Increased calcium/metabolic requirement (bone growth, after pregnancy, bisphosphonates, loop diuretics, rhabdomyolysis, sepsis)

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4
Q

Epidemiology of Hyperparathyroidism

A

Primary hyperPTH is the most common cause of hypercalcaemia in outpatients

All dialysis-dependent chronic renal failure patients develop secondary hyperPTH

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5
Q

Symptoms of Primary Hyperparathyroidism

A

Most are asymptomatic (Developed countries)

> 80% symptomatic in poor-resource nations

Psychic groans: Fatigue, anxiety, depression, poor sleep, memory loss
Abdominal moans: abdo pain, constipation, anorexia, nausea, pancreatitis, dyspepsia
Neck lump
Stones: severe loin to groin pain

Bone pain and frequent fractures (osteoporosis)
Myalgia 
Parasthaesia 
Muscle cramps
Polyuria, polydipsia
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6
Q

Symptoms of Secondary Hyperparathyroidism

A

Muscle cramps and bone pain
Peri-oral tingling
Paraesthesia (hands, mouth, feet, lips)
Convulsions

Hx of fractures

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7
Q

Signs of primary Hyperparathyroidism

A

Neuromuscular dysfunction
Cardiovascular dysfunction
Hard, dense neck mass

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8
Q

Signs of secondary Hyperparathyroidism

A

Chvostek’s sign
Trousseau’s sign
Bowed legs/knock knees (vit D deficiency)

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9
Q

Investigations for Hyperparathyroidism

A

Serum calcium, phosphate, PTH, vit D:
- Primary: ↑ calcium, ↓ phosphate, ↑ PTH
- Secondary: ↓ calcium, ↓ phosphate, ↑ PTH
- Tertiary: ↑ calcium, ↑ phosphate, ↑ PTH
Sestamibi scanning: +ve for solitary adenoma or multi-gland involvement, shows hyperplasia
USS neck: parathyroid gland hyperplasia

24h urinary calcium: high/normal (primary), low in familial hypocalciuric hypercalcaemia

Serum alk phos: may be raised

DEXA scan: Identify osteoporosis

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10
Q

Management for acute hypercalcaemia

A

IV fluids, 4-6 in 24h

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11
Q

Management for Primary Hyperparathyroidism

A

Parathyroidectomy
+ vit D supplements (ergocalciferol), bisphosphonates and cinacalcet

Check Ca/PTH at 2 weeks and 6 months

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12
Q

Management for secondary Hyperparathyroidism

A

Treat underlying cause

Calcium + vit D supplements

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13
Q

Complications of Hyperparathyroidism

A

Primary: bone resorption, renal tubular calcium reabsorption, hypercalcaemia

Secondary: bone resorption + turnover - osteitis fibrosa cystica

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14
Q

Prognosis for Hyperparathyroidism

A

Primary: surgery is curative for benign disease

Secondary/tertiary: prognosis same as CKD

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