Primary Hyperparathyroidism

Question 1

Define primary hyperparathyroidism.

Answer 1

Primary hyperparathyroidism (PHPT) is an endocrine disorder in which autonomous overproduction of parathyroid hormone (PTH) results in derangement of calcium metabolism.

Question 2

Explain the aetiology/risk factors of primary hyperparathyroidism.

Answer 2

Female sex
Age ≥50-60 years
Family history of PHPT
Multiple endocrine neoplasia (MEN) 1, 2A, or 4
Current or historical lithium treatment
Hyperparathyroidism-jaw tumour syndrome

Question 3

Summarise the epidemiology of primary hyperparathyroidism.

Answer 3

Primary hyperparathyroidism is a relatively common disorder affecting 1 in 500 women and 1 in 2000 men aged over 40 years. A population-based study suggested 2% of post-menopausal women have PHPT, with the disorder being the most common cause of hypercalcaemia in outpatients.

Question 4

Recognise the presenting symptoms of primary hyperparathyroidism. Recognise the signs of primary hyperparathyroidism on physical examination.

Answer 4

History of osteoporosis or osteopenia
Bone pain
Poor sleep
Fatigue
Anxiety
Depression
Memory loss
Myalgias
Paraesthesias
Muscle cramps
Constipation

Question 5

Identify appropriate investigations for primary hyperparathyroidism and interpret the results.

Answer 5

Serum calcium
Serum intact PTH with immunoradiometric or immunochemical assay

Question 6

Generate a management plan for primary hyperparathyroidism.

Answer 6

1st line: Parathyroidectomy
Adjunct: Vitamin D supplementation

2nd line: Monitoring
Adjunct:
Bisphosphonate
Cinacalcet
Vitamin D supplementation

Question 7

Identify the possible complications of primary hyperparathyroidism and its management.

Answer 7

Neck haematoma following surgery
Recurrent and superior laryngeal nerve injury following surgery
Hypocalcaemia following surgery
Pneumothorax following surgery
Osteoporosis
Bone fractures
Nephrolithiasis

Question 8

Summarise the prognosis for patients with primary hyperparathyroidism.

Answer 8

For asymptomatic patients who do not meet the criteria for surgical intervention, 75% have stable disease for up to 10 years. Twenty-five percent of patients progress to meeting criteria for parathyroidectomy.
Parathyroidectomy has a cure rate of over 95% and as high as 99% in expert hands.