Parathyroid glands and disorders of calcium metabolism Flashcards
PTH (Elevated)
Ca2+ (Elevated)
Phosphate (Low)
Urine calcium : creatinine clearance ratio > 0.01
Primary Hyperparathyroidism
Symptoms of Primary Hyperparathyroidism
May be asymptomatic if mild
Recurrent abdominal pain (pancreatitis, renal colic)
Changes to emotional or cognitive state
Cause of Primary Hyperparathyroidism
solitary adenoma (80%)
multifocal disease in 10-15%
parathyroid carcinoma in ~1%
PTH (Elevated)
Ca2+ (Low or normal)
Phosphate (Elevated)
Vitamin D levels (Low)
Secondary Hyperparathyroidism
Symptoms of Secondary Hyperparathyroidism
May have few symptoms
Eventually may develop:
- bone disease
- osteitis fibrosa cystica
- soft tissue calcifications
Cause of Secondary Hyperparathyroidism
Parathyroid gland hyperplasia due to low calcium
(almost always in a setting of chronic renal failure)
Ca2+ (Normal or high)
PTH (Elevated)
Phosphate levels (Decreased or Normal)
Vitamin D (Normal or decreased)
Alkaline phosphatase (Elevated)
Tertiary hyperparathyroidism
Symptoms of Tertiary Hyperparathyroidism
Metastatic calcification
Bone pain and / or fracture
Nephrolithiasis
Pancreatitis
Cause of Tertiary Hyperparathyroidism
ongoing hyperplasia of the parathyroid glands
after correction of underlying renal disorder
=> hyperplasia of all 4 glands is usually the cause
Indications for surgery in Primary Hyperparathyroidism
Elevated serum Calcium > 1mg/dL above normal
Hypercalciuria > 400mg/day
Creatinine clearance < 30% compared with normal
Episode of life threatening hypercalcaemia
Nephrolithiasis
Age < 50 years
Neuromuscular symptoms
Reduction in bone mineral density of the femoral neck, lumbar spine, or distal radius
indications for surgery in Secondary (Renal) Hyperparathyroidism
**NOTE usually medically managed
Bone pain
Persistent pruritus
Soft tissue calcifications