Hyperparathyroidism

Question 1

Define it

Answer 1

Abnormally high PTH levels in blood due to overactivity of the parathyroid glands

Question 2

What does PTH do

Answer 2

increases serum calcium & decreases serum phosphate. Secretion is stimulated by decrease in serum calcium

Question 3

Epidemiology

Answer 3

F>M
>50 years

Question 4

What causes primary HPT?

Answer 4

Parathyroid gland adenoma (benign tumour)- would see high calcium level

Question 5

What are causes of secondary HPT?

Answer 5

• CKD
• Malnutrition
• Vitamin D deficiency (reduced sunlight or nutritional deficiency)

Would see low calcium levels

Question 6

What causes tertiary HPT?

Answer 6

Caused by persistent sHPT
Hyperplasia of parathyroid glands after correction of underlying renal disorder
- would see high calcium levels due to chronic increase in PTH

Question 7

CF of primary HPT

Answer 7

Painful bones, renal stones, abdo groans and psychic moans (hypercalcaemia symptoms)

• Polydipsia
• Polyuria
• Anorexia
• Nausea
• Constipation
• Bone pain (esp back pain)
• Renal stones
• Low mood

Question 8

CF of secondary and tertiary HPT

Answer 8

• Symptoms of underlying cause (i.e. renal failure)
• Bone pain
• Increased risk of fractures

Question 9

How can we tell the difference between primary and tertiary?

Answer 9

• PTH raised or inappropriately normal in primary
• Markedly raised in tertiary
• ALP is raised in primary

Question 10

What would we look for to diagnose secondary

Answer 10

• Low calcium
• Low phosphate if vitamin D deficiency (osteomalacia)
• High phosphate if CKD

Question 11

What scan can we do and why?

Answer 11

USS to look for parathyroid gland adenoma

Question 12

What would an X-ray show

Answer 12

• Pepperpot appearance
• osteopenia/erosion of bone

Question 13

How do we treat pHPT definitively?

Answer 13

Total parathyroidectomy

Question 14

What medical management can we use and what does each do?

Answer 14

• Calcimimetics (Cinacalcet) which inhibits PTH release
• IV fluids to treat hypercalcaemia

Question 15

How do we treat secondary HPT

Answer 15

Treat the underlying cause (i.e. CKD, vit D deficiency)