Hyperparathyroidism

Question 1

What is hyperparathyroidism?

Answer 1

A condition caused by excessive secretion of parathyroid hormone (PTH)

Question 2

What is the main physiological effect of excess PTH?

Answer 2

Increased serum calcium due to increased bone resorption, renal calcium reabsorption, and intestinal calcium absorption

Question 3

What are the three main types of hyperparathyroidism?

Answer 3

Primary, secondary, and tertiary hyperparathyroidism

Question 4

What causes primary hyperparathyroidism?

Answer 4

Autonomous overproduction of PTH from the parathyroid glands

Question 5

What is the most common cause of primary hyperparathyroidism?

Answer 5

Solitary parathyroid adenoma (≈85%)

Question 6

What other causes of primary hyperparathyroidism exist?

Answer 6

Gland hyperplasia, multiple adenomas, and parathyroid carcinoma

Question 7

Which patient group most commonly has primary hyperparathyroidism?

Answer 7

Outpatients with incidental hypercalcaemia

Question 8

How do most patients with primary hyperparathyroidism present?

Answer 8

Asymptomatically on routine blood tests

Question 9

What classic mnemonic describes symptoms of primary hyperparathyroidism?

Answer 9

Bones, stones, abdominal groans, and psychic moans

Question 10

What bone-related symptoms occur in primary hyperparathyroidism?

Answer 10

Bone pain, fractures, osteoporosis, osteitis fibrosa cystica

Question 11

What renal features are seen in primary hyperparathyroidism?

Answer 11

Polyuria, polydipsia, nephrolithiasis

Question 12

What gastrointestinal symptoms are associated with hyperparathyroidism?

Answer 12

Anorexia, nausea, constipation, peptic ulcer disease, pancreatitis

Question 13

What neuropsychiatric features may occur in hyperparathyroidism?

Answer 13

Depression, lethargy, fatigue, memory impairment, psychosis

Question 14

What cardiovascular association is seen with primary hyperparathyroidism?

Answer 14

Hypertension

Question 15

Which genetic syndromes are associated with primary hyperparathyroidism?

Answer 15

MEN type 1 and MEN type 2

Question 16

What biochemical pattern is typical of primary hyperparathyroidism?

Answer 16

High calcium, low phosphate, raised or inappropriately normal PTH

Question 17

Why may PTH be “normal” in primary hyperparathyroidism?

Answer 17

It is inappropriately normal in the presence of hypercalcaemia

Question 18

What imaging is used to localise a parathyroid adenoma?

Answer 18

Technetium-99m sestamibi (MIBI) scan

Question 19

What classic skull X-ray finding is seen in severe disease?

Answer 19

Pepperpot skull

Question 20

What bone disease results from prolonged severe hyperparathyroidism?

Answer 20

Osteitis fibrosa cystica

Question 21

What is the definitive treatment for primary hyperparathyroidism?

Answer 21

Parathyroidectomy

Question 22

When can conservative management be considered in primary hyperparathyroidism?

Answer 22

Age >50, calcium <0.25 mmol/L above upper limit, and no end-organ damage

Question 23

What drug can be used if surgery is not suitable?

Answer 23

Cinacalcet

Question 24

What is the mechanism of action of cinacalcet?

Answer 24

A calcimimetic that activates the calcium-sensing receptor and suppresses PTH

Question 25

What causes secondary hyperparathyroidism?

Answer 25

Chronic hypocalcaemia due to vitamin D deficiency, malabsorption, or chronic kidney disease

Question 26

What is the most common cause of secondary hyperparathyroidism?

Answer 26

Chronic kidney disease

Question 27

What biochemical pattern is seen in secondary hyperparathyroidism?

Answer 27

Low or normal calcium, high PTH, phosphate low or high depending on cause

Question 28

Why does chronic kidney disease cause secondary hyperparathyroidism?

Answer 28

Reduced vitamin D activation, phosphate retention, and hypocalcaemia

Question 29

What is tertiary hyperparathyroidism?

Answer 29

Autonomous PTH secretion after long-standing secondary hyperparathyroidism

Question 30

What biochemical pattern is typical of tertiary hyperparathyroidism?

Answer 30

High calcium, high phosphate, high PTH

Question 31

How is secondary hyperparathyroidism managed?

Answer 31

Treat underlying cause, vitamin D replacement, phosphate binders

Question 32

How is tertiary hyperparathyroidism managed?

Answer 32

Cinacalcet or subtotal/total parathyroidectomy

Question 33

What are the major complications of untreated hyperparathyroidism?

Answer 33

Osteoporosis, renal stones, pancreatitis, peptic ulcer disease