what is hyperparathyroidism
excess prod of PTH from parathyroid gland
describe the causes of the 3 types of hyperparathyroidism
primary:
- due to parathyroid gland itself
- parathyroid adenoma/carcinoma
- parathyroid hyperplasia
- drug induced e.g. lithium
secondary:
- stimulus is low Ca2+
- kidney disease e.g. CKD
- vit D (1,25-dihydroxycholecalciferol) deficiency
tertiary:
- prolonged secondary hyperparathyroidism –> hyperplasia
what is the most common cause of primary hyperparathyroidism
parathyroid adenoma (80% cases)
what are the regulators of parathyroid hormone
- low Ca2+
- high phosphate
- low Mg2+
what is the name of the active form of vitamin D
1,25-dihydroxycholecalciferol
or calcitriol
describe the presentation of a Px w/ hyperparathyroidism
bones, moans, groans, and stones
bones - bone pain, osteoporosis
moans - fatigue, depression, CNS disturbance, muscle weakness
groans - GI disturbance, abdominal pain, operatic ulcer
stones - kidney stones
what investigation can be done in suspected hyperparathyroidism
- check serum calcium, PTH, phosphate (and alkaline phosphate)
- DEXA scan (may show osteopenia), urine calcium
ensure other causes of hypercalcaemia excluded before considering diagnosis of hyperparathyroidism, e.g. thiazide diuretics which are calcium sparing
describe the results of serum tests that would be seen in primary/secondary/tertiary hyperparathyroidism
primary:
- ⬆️ PTH
- ⬆️ serum calcium
- ⬇️ serum phosphate
secondary:
- ⬆️ PTH
- ⬇️ serum calcium
- ⬆️ serum phosphate
tertiary:
- ⬆️ PTH
- ⬆️ serum calcium
- ⬇️ serum phosphate
(ALP raised for all)
outline management of hyperparathyroidism
primary:
- increase oral fluids, monitor PTH
- biphosphonates –> prevent/reduce osteoporosis
secondary:
- treat cause
- diet low in phosphates, high in calcium
- calcimimetics e.g. cinacalcet
parathyroidectomy is definitive
what are some secondary symptoms as a result of hyperparathyroidism
- osteomalacia
- rickets
- renal osteodystrophy
what are some complications of hyperparathyroidism
- renal calculi
- acute pancreatitis
- peptic ulceration
- calcification of cornea
