what is the hormone profile in primary hyperparathyroidism?
- PTH = elevated
- Ca2+ = elevated
- phosphate = low
- urine calcium : creatinine clearance ratio >0.01
what are the clinical features of primary hyperparathyroidism?
- can be asymptomatic
- recurrent abdominal pain
- changes to emotional or cognitive state
what are the causes of primary hyperparathyroidism?
parathyroid pathology
* solitary adenoma (80%)
* multifocal disease
* parathyroid carcinoma
what is the most common cause of primary hyperparathyroidism?
solitary adenoma
what is the hormone profile in secondary hyperparathyroidism?
- PTH = elevated
- Ca2+ = low or normal
- phosphate = elevated
- vitamin D = low
what are the clinical features of secondary hyperparathyroidism?
may have few symptoms. will eventually develop:
* bone disease
* osteitis fibrosa cystica
* soft tissue calcifications
what is the pathophysiology of secondary hyperparathyroidism?
- insufficient **vitamin D **or chronic renal failure
- low absorption of calcium from the intestines, kidneys and bones
- causes hypocalcaemia
- parathyroid excretes more PTH
- resulting **parathyroid hyperplasia **
what is the most common cause of secondary hyperparathyroidism?
chronic renal failure
what is the hormonal profile of teritary hyperparathyroidism?
- PTH = elevated
- Ca2+ = normal or high
- phosphate = low or normal
- vitamin D = low or normal
- alkaline phosphate = elevated
what are the clinical features of tertiary hyperparathyroidism?
- metastatic calcification
- bone pain and/or fracture
- nephrolithiasis
- pancreatitis
what is the pathophysiology of tertiary hyperparathyroidism?
result of ongoing hyperplasia of the parathyroid glands after correction of underlying renal disorder
what are the symptoms of hypercalcaemia?
- renal stones
- painful bones
- abdominal groans - constipation, nausea, vomiting
- psychiatric moans - fatigue, depression, psychosis
how is primary hyperparathyroidism managed?
surgically removing the tumour
how is secondary hyperparathyroidism managed?
- correcting the vitamin D deficiency
- performing renal transplant to treat renal failure
how is tertiary hyperparathyroidism managed?
surgically removing part of the parathyroid tissue to return the parathyroid hormone to an appropriate level
