what does increased levels of PTH result in?
high serum calcium
primary disease causes
small adenomas (single gland involved, other atrophic)
hyperplasia (typically involves all glands and is associated with MEN1/2a)
carcinoma
secondary disease cause
chroinc hypocalcaemia with compensatory over-activity of parathyroid glands (hyperplasia)
- renal failure
- low calcium intake
- vitamin D deficiency
tertiary disease causes
hyperplasia from secondary hyperparathyroidism causes autonomous activity associated with hypercalcaemia
presentation of hyperparathyroidism
- bone= pain, fracture, osteoporosis or osteitis fibrosa cystica
- nephron= stones
- GI= constipation, peptic ulcer disease, pancreatitis, gall stones
- CNS= depression, lethargy, seizures
- neuromuscular= weakness and fatigue
- CVS= calcification of aortic and mitral valves
diagnosis
sestamibi scan (two isotopes) bloods for hormones and calcium, phosphate, PTH
diagnosis of primary
high calcium and PTH
secondary diagnosis
low calcium and high PTH
tertiary diagnosis
high calcium and PTH (much higher than primary)
management
- surgery to remove
- cinacalet= calcium mimetic used in tertiary and carcinoma
- fluids and low calcium and vitamin D diet
when should surgery be encouraged?
renal stones
renal impairment
osteoporosis
indications for parathyroidectomy
under 50
reduced kidney function (eGFR <60mL/min)
end organ damage e.g. osteitis fibrosa cystica, Brown’s tumours, gastric ulcer, kidney stones, OP, bone cysts and fibrosis)
what can chronic renal disease lead to?
vitamin D deficiency and secondary hyperparathyroidism
management of secondary hyperparathyroidism with chronic renal disease
titre treatment to PTH levels and phosphate binders
