Hyperparathyroidism

Question 1

What cells in the parathyroid glands produce PTH?

Answer 1

chief cells

Question 2

List 4 actions of PTH

Answer 2

1. ↑ osteoclast activity
2. ↑ Ca2+ absorption from gut
3. ↑ Ca2+ absorption from kidneys
4. ↑ vitamin D activity

Question 3

Relationship between PTH and Vitamin D?

Answer 3

PTH acts on Vit D to convert it into active forms

Question 4

Action of Vit D?

Answer 4

Increases calcium absorption from the intestines

Question 5

List 4 symptoms of hypercalcaemia

‘stones, moans and groans’

Answer 5

1. Renal stones
2. Painful bones
3. Abdominal groans → constipation, nausea and vomiting
4. Psychiatric moans → fatigue, depression and psychosis

Question 6

What is primary hyperparathyroidism?

Answer 6

Caused by uncontrolled PTH due to a tumour of the parathyroid glands

Question 7

Treatment of primary hyperparathyroidism?

Answer 7

Surgery

Question 8

What is secondary hyperparathyroidism?

Answer 8

1. Insufficient Vit D or CKD leads to low absorption of Ca2+ from intestines, kidneys and bones
2. Parathyroid glands reacts by secreting more PTH
3. Over time this leads to hyperplasia

Question 9

Treatment of secondary hyperparathyroidism

Answer 9

1. Correcting the vitamin D deficiency OR
2. Renal transplant for CKD

Question 10

What is tertiary hyperparathyroidism?

Answer 10

Due to hyperplasia of the gland as a result of long term secondary hyperparathyroidism

• Baseline levels of PTH increase dramatically
• Even when cause is treated, PTH levels remain high → hypercalcaemia

Question 11

What is the most likely diagnosis:

• High PTH
• High Calcium

Answer 11

1. Primary hyperparathyroidism (tumour) OR
2. Tertiary hyperparathyroidism (hyperplasia)

Question 12

What is the most likely diagnosis:

• High PTH,
• Low/ Normal Calcium

Answer 12

Secondary hyperparathyroidism (Low Vit D or CKD)