Hyperparathyroidism HPT Flashcards
What is hyperparathyroidism (HPT)?
Disorder of calcium metabolism due to excessive PTH secretion
HPT leads to increased calcium levels in the blood.
What are the types of hyperparathyroidism?
- Primary HPT (PHPT)
- Secondary HPT
- Tertiary HPT
What is primary hyperparathyroidism (PHPT)?
Excessive PTH due to parathyroid adenoma, hyperplasia, or carcinoma
What causes secondary hyperparathyroidism?
Compensatory PTH increase due to hypocalcemia (e.g., renal failure, vitamin D deficiency)
What is tertiary hyperparathyroidism?
Autonomous PTH secretion after prolonged secondary HPT
What is the prevalence of PHPT in the U.S.?
42 in 100,000
What is the female-to-male ratio for PHPT?
3:1
How does the incidence of PHPT change with age?
Increases with age; 3–4 in 1000 postmenopausal women
What genetic mutations are associated with PHPT?
Alter parathyroid chief cells → ↑ PTH secretion
What are anatomic changes associated with PHPT?
- Single adenoma (85%)
- Four-gland hyperplasia (10%)
- Parathyroid carcinoma (<1%)
What are key lab findings in the diagnosis of PHPT?
- Elevated or high-normal PTH
- Hypercalcemia
- Hypophosphatemia
- Normal-to-high urinary calcium
What is the clinical presentation of PHPT?
- Asymptomatic (85%)
- Symptoms: Kidney stones, bone pain, fatigue, neuropsychiatric changes
What are the diagnostic criteria for PHPT?
Persistent hypercalcemia + elevated PTH; rule out secondary causes
What is Familial Hypocalciuric Hypercalcemia (FHH)?
- Autosomal dominant
- Low urinary calcium (FECa <1%)
- Genetic testing may be needed
How is malignancy-associated hypercalcemia characterized?
Low PTH, elevated PTHrP
What are common symptoms of PHPT?
- Kidney stones
- Osteoporosis
- Bone pain
- Muscle weakness
- Neuropsychiatric changes
What is the classic triad of symptoms in PHPT?
Kidney stones, painful bones, abdominal groans, psychic moans, fatigue overtones
What lab tests are used in the diagnostic workup of PHPT?
- Serum calcium
- PTH
- Phosphate
- 25-OH vitamin D
- Urinary calcium (FECa)
What imaging techniques are used to localize adenomas in PHPT?
- Sestamibi SPECT
- Ultrasound
- 4D-CT
What are the indications for surgical treatment of asymptomatic PHPT?
- Serum calcium >1 mg/dL above normal
- Osteoporosis (T-score ≤-2.5) or fragility fracture
- eGFR <60 mL/min
- Nephrolithiasis or nephrocalcinosis
- Age <50 years
What are the surgical options for treating PHPT?
- Minimally Invasive Parathyroidectomy (MIP)
- Standard Neck Exploration
What medical management options are available for PHPT?
- Calcimimetics (Cinacalcet, Etelcalcetide)
- Bisphosphonates
- Vitamin D Supplementation
How often should asymptomatic PHPT be monitored?
- Annual serum calcium, PTH, eGFR
- DXA every 1–2 years
- Office visits every 6 months
What is the most common cause of hypercalcemia?
Primary hyperparathyroidism (PHPT)
What is the definitive treatment for PHPT?
Surgical cure
What should be monitored regularly in patients with PHPT?
- Bone density
- Renal function
- Calcium levels
