Primary Hyperparathyroidism Flashcards
Etiology of primary hyperparathyroidism
parathyroid adenoma (most common), hyperplasia, carcinoma increased risk in MEN types 1 and 2A
symptoms of primary hyperparathyroidism
asymptomatic (most common)
mild non specific symptoms (Fatigue, constipation)
abdominal pain, renal stones, bone pain, and neuropsychiatric symptoms
diagnostic findings of primary hyperparathyroidism
hypercalcemia
elevated or inappropriate normal PTH
elevated 24 hr urinary Ca excretion
Indications for parathyroidectomy
age<50 yrs
symptomatic hypercalcemia
complications of primary hyperparathyroidism: osteoporosis, nephrolithiasis/calcinosis, CKD (GFR<60)
Elevated risk of complications: Calcium >1mg/dl above normal and urinary calcium excretion >400 mg/day
how do diagnose primary hyperparathryoidism?
persistent hypercalcemia with elevated PTH
normally if high Calcium should see low PTH
how do we see primary hyperparathyroidism
incidentally with lab findings as most pts are asymptomatic
long term complications for primary hyperparathyroidism
osteoporosis, nephrolithasis and CKD
definitive treatment for primary hyperparathyroidism
parathyroidectomy
young pts who are <50 yrs should get this because they are at risk for CKD and osteoporosis later in life.
Other pts are at elevated risk if they have elevated Ca (serum Ca >1mg/dl above normal and excessive urinary calcium loss >400 mg/day.
what should be done to determine if pt needs parathyroidectomy if the patient doesn’t have overt complications
what are abnormal results?
How to follow pt?
get a 24 hr urine calcium measurement. Can also identify familial hypocalcuric hypercalcemia.
if urinary calcium excretion <400 mg/day she doens’t need surgery
needs Serum Ca and Cr every year and DEXA every 1-2 yrs
other causes of PTH dependent hypercalcemia
familial hypocalcuric hypercalcemia.
Causes more reabsorption of Ca from urine so low Ca in urine.
If surgery is required for primary hyperparathyroidism, what is done prior to surgery
get a neck u/s and technetium 99m sestamibi CT to see location of parathyroid adenoma
in pt who has severe primary hyperparathyroidectomy it’s important to check
25 hydroxyvitamin D level to correct vitamin D deficiency to avoid post operative hypocalcemia.
what helps to lower PTH levels in primary hyperparathyroidism ?
correcting vitamin D deficiency
Vitamin D deficiency is common in pts with primary hyperparathyroidism due to increased conversion of 25 hydroxyvitamin D to 1,25 dihydroxyvitamin D.
Supplementation of vitamin D has helps to decrease parathyroid hormone levels, decrease bone turnover and improve bone mineral density.
