primary hyperparathyroidims

Question 1

what are the causes of primary hyperparathyroidism?

Answer 1

Causes of primary hyperparathyroidism 
80%: solitary adenoma
15%: hyperplasia
4%: multiple adenoma
1%: carcinoma

Question 2

what are the symptoms?

Answer 2

symptoms of Hypercalcaemia-> bones, stones, abdominal groans and psychiatric moans

• polyuria and polydipsia
• depression
• anorexia, nausea nad consitpation
• peptic ulceration
• bone pain and fractures-> due to osteopenia
• pancreatitis
• renal stones
• hypertension

Question 3

which diseases are associated with primary hyperparathyroidism?

Answer 3

hypertension

multiple endocrine neoplasia: MEN I and II

Question 4

what will investigations for primary hyperparathyroidism show?

Answer 4

• raised calcium, low phosphate
• PTH may be raised or (inappropriately, given the raised calcium) normal
• pepperpot skull is a characteristic X-ray finding of hyperparathyroidism

Question 5

what is the definitive management for primary hyperparathyroidism?

Answer 5

total parathyroidectomy

Question 6

what is the conservative management for primary hyperparathyroisim?

Answer 6

• this may be offered to patients with calcium >0.25 the upper limit of normal and >50 yrs with no evidence of end organ damage
• tx with cincalcet or calcimimetic

Question 7

how does calcimimetic work?

Answer 7

mimics the action of calcium by allosteric binding of calcium sensing receptors

Question 8

what are the common causes of secondary hyperparathyroidism?

Answer 8

• CKD and Vit D deficiency because they reduce absorption of calcium
• this leads to parathyroid glad hyperplasia
• the hyperplasia will resolve if the kidney disease and vitamin D deficiency are resolved

Question 9

what are the complications of parathyroidectomy?

Answer 9

1. Hypocalcaemia: there may be rebound hypocalcaemia following surgery
2. Recurrent laryngeal nerve injury: following removal of the parathyroid glands
3. Post-operative haematoma: may require evacuation

Question 10

what will bloods for secondary hyperparathyroidism look like?

Answer 10

• calcium low or normal
• parathyroid hormone high
• vit D low
• phosphate can be high or low