Primary Hyperparathyroidism

Question 1

Aetiology of primary hyperparathyroidism?

Answer 1

85% parathyroid adenoma

15% four gland hyperplasia

<1% parathyroid cancer

Question 2

What is primary hyperparathyroidism?

Answer 2

High PTH secretion

Question 3

What are the symptoms of HPT?

Answer 3

Bone disease

Asymptomatic

Nephrolithiasis

Question 4

What is the required serum calcium level for a diagnosis?

Answer 4

> 0.25mmol/l above normal range

Question 5

What is normal serum calcium levels?

Answer 5

2.2 - 2.7 mmol/l

Question 6

So what level indicates hyperparathyroidism?

Answer 6

Around 3 mmol/l

Question 7

What blood tests should be done?

Answer 7

Serum calcium

Serum PTH

Question 8

What imaging studies should be done?

Answer 8

USS of ureters (or CTKUB)
- For nephrolithiasis

USS Parathyroid

• Adenoma
• Hyperplasia
• Cancer

SESTAMIBI Scan

Question 9

What is a SESTAMIBI scan?

Answer 9

Basically a PET

Allows good localisation of a parathyroid adenoma as they absorb more of the radioisotope

Question 10

Surgical treatment?

Answer 10

Resection of adenoma

Question 11

Pharmacological treatment?

Answer 11

Cinacalcet

Question 12

What does cinacalcet do?

Answer 12

Lowers PTH levels