Parathyroid: hyperparathyroidism, hypoparathyroidism

Question 1

Define hypoparathyroidism?

Answer 1

Refers to insufficient parathyroid hormones being produced.

Question 2

Causes of hypoparathyroidism?

Answer 2

Primary hypoparathyroidism
- autoimmune

Secondary hypoparathyroidism
- surgical removal of thyroid or parathyroid

Question 3

Presentation of hypoparathyroidism?

Answer 3

• paraesthesia (tingling sensation)
• perioral tingling
• Chovstek sign: facial muscle contraction on tapping the facial nerve in front of the ear.
• Trosseau sign: corpal spasm after BP cuff inflated.
• muscle pains or cramps and tetany (spasms), hyperreflexia
• tiredness, irritability
• mood change -anxiety, depressed (chronic)
• dry, rough skin (chronic)
• hair fallout (chronic)
• finger nails that break easily (chronic)
• cataracts (clouding of the lens of the eyes)

Question 4

Diagnosis/IVx of hypoparathyroidism?

Answer 4

Diagnosed after blood test shows:
- low parathyroid hormone levels
- bone profile: low calcium, high phosphorus levels
- LFTs: normal ALP
- Urine: low calcium

Question 5

Management of hypoparathyroidism?

Answer 5

• calcium and vitamin D supplements
• diet -high calcium food, low phosphorus food
• Acute medical: IV calcium gluconate +/-magnesium sulphate if low.

Question 6

Define hyperparathyroidism?

Answer 6

refers to excess parathyroid hormone being produced by the parathyroid gland.

Question 7

Define primary hyerparathyroidism? What does it lead to?

Answer 7

refers to uncontrolled parathyroid hormone production by a TUMOUR of the parathyroid glands. (parathyroid adenoma 80%).

Leads to hypercalcaemia.

Question 8

Define secondary hyerparathyroidism? What does it lead to?

Answer 8

refers to INSUFFICIENTvitamin DorCKDREDUCES calcium absorption from the intestines, kidneys and bones.

Leads to hypocalcaemia.

Question 9

What is tertiary hyperparathyroidism? What does it lead to?

Answer 9

occurs when secondary hyperparathyroidism continues for a long period after underlying cause treatment.

hyperplasia of the parathyroid glands.

Leads to hypercalcaemia.

Question 10

Presentation of hyerparathyroidism?

Answer 10

• asymptomatic
• “stones, bones, moans and abdominal groans”
• fatigue overtones

Question 11

Diagnosis/IVx of hyerparathyroidism?

Answer 11

Bone profile (hypercalcaemia, LOW phosphate)
LFTs (high ALP)
High parathyroid hormone

24 hr urine (high calcium ions, BENCE JONES PROTEIN)

LOW vitamin D

US or MRI

Question 12

Management of hyerparathyroidism?

Answer 12

Conservative:
- rule out multiple myeloma, malignancies, sarcoidosis
- monitor regularly
- steady (not high) calcium intake to prevent bone loss
- keep well hydrated

Medical:
- Chronic: calcium and vitamin D supplements

• Acute: IV calcium gluconate +/-magnesium sulphate (if low)

Surgical:
- parathyroidectomy