hyperparathyroidism

Question 1

how many parathyroid glands are there?

Answer 1

4

Question 2

what cells secrete PTH?

Answer 2

chief cells

Question 3

what triggers chief cells to release PTH?

Answer 3

low calcium levels

Question 4

what effect does PTH have?

Answer 4

increases Ca2+ levels

• increases absorption of Ca2+ in the intestines
• increases reabsorption of Ca2+ in the kidneys so less is excreted in the urine
• increases osteoclast activity so increase of bone being broken down and Ca2+ released into blood
• converts Vitamin D into its active form, active vitamin D also increases absorption of Ca2+ in intestines, increases reabsorption of Ca2+ in kidneys and increases osteclast activity

Question 5

what effect can a vitamin D deficiency have on Ca+ levels?

Answer 5

-can lead to low calcium levels

Question 6

what type of hyperparathyroidism are there?

Answer 6

• primary
• secondary
• tertiary

Question 7

what causes primary hyperparathyroidism?

Answer 7

-a tumour in the parathyroid glands

Question 8

what is the pathophysiology of hyperparathyroidism?

Answer 8

• there is a tumour in the parathyroid glands
• tumour leads to increased PTH
• increased PTH leads to increased osteclast activity, increased absorption of Ca2+ in the intestines and increased reabsorption of Ca2+ in kidneys leading to hypercalcaemia

Question 9

what are the PTH and Ca2+ levels like in primary hyperparathyroidism?

Answer 9

PTH= high
Ca2+ = high

Question 10

what is the treatment for primary hyperparathyroidism?

Answer 10

1st line= surgical removal of parathyroid tumour
2nd line= cinacelet (lowers Ca2+ and PTH levels)

screen for MEN

Question 11

what is the cause for secondary hyperparathyroidism?

Answer 11

• low Ca2+ intake
• chronic renal failure
• decrease in vitamin D intake

Question 12

what is the treatment for secondary hyperparathyroidism?

Answer 12

chronic renal failure= sevelamer

Vit D deficiency= vit D supplement

low Ca2+= calcium supplement

Question 13

what is the pathophysiology of secondary hyperparathyroidism?

Answer 13

• hypocalcaemia due to chronic renal disease, low Ca2+ intake or Vit D deficiency
• hypocalcaemia leads to increase PTH levels
• chronic hypocalcaemia can lead to increase baseline levels of PTH

Question 14

what are the Ca2+ levels and the PTH levles like in secondary hyperparathyroidism?

Answer 14

• Ca2+ levels low

- PTH levels high

Question 15

what causes tertiary hyperparathyroidism?

Answer 15

secondary hyperplasia occurred for so long that it has lead to hyperplasia of parathyroid glands causing them to secrete more PTH even when Ca2+ levels are normal

Question 16

what are the PTH levels and Ca2+ levels like in tertiary hyperparathyroidism?

Answer 16

PTH= high
Ca2+= high

Question 17

what is the treatment for tertiary hyperparathyroidism?

Answer 17

• surgical removal of excess parathyroid gland tissue

- cinacelet may be used (lowers PTH and calcium)

Question 18

how does hyperparathyroidism present?

Answer 18

• frequent urination/ increased thirst
• loss of appetite/ weight loss
• fatigue
• depression
• bone pain
• constipation
• gall stones, kidney stones