hypo- + hyper- parathyroidism Flashcards
primary hyperparathyroidism
caused by excess secretion of PTH resulting in hypercalcaemia
causes of hyperparathyroidism
85% - solitary adenoma
10% - hyperplasia
4% - multiple adenoma
1% - carcinoma
hyperparathyroidism xray findings
- “pepperpot skull”
- osteitis fibrosa cystica - formation of cyst like brown tumours around the bone
generalised osteopenia
loss of bone mass
calcified supporting structures are replaced with fibrous tissue
primary hyperparathyroidism presentation
80% asymptomatic
hypercalcaemia;
- bones - pain/fractures
- stones - renal stones
- abdominal groans - anorexia, constipation
- psychic moans - depression
polyuria/dipsia
conditions assoc with primary hyperparathyroidism
hypertension
MEN I + II
primary hyperparathyroidism investigations
bloods
- raised calcium, LOW phosphate
- PTH raised or inappropriatley normal given raised calcium
technetium-MIBI subtraction scan
Xray ! - pepperpot skull!
management of primary hyperparathyroidism
definitive = total parathyroidectomy
patients not suitable for surgery = cinacalcet
- a calcimimetic - mimics action of calcium on tissues
hormone profile in primary hyperparathyroidism
PTH - elevated
Ca - elevated
phosphate - low
hormone profile in secondary hyperparathyroidism
PTH - elevated
Ca - low or normal
phosphate - elevated
hormone profile in secondary hyperparathyroidism
PTH - elevated
Ca - normal or high
phosphate - decreased
clinical features in tertiary hyperparathyroidism
metastatic calcification
bone pain/ fractures
nephrolithiasis
pancreatitis
cause of secondary hyperparathyroidism
parathyroid hyperplasia as a result of low calcium
– almost always in a setting of chronic renal failure
indications for surgery in secondary hyperparathyroidism
bone pain
persistent pruritis
soft tissue calcifications
