Parathyroid

Question 1

Primary hyperparathyroidism

Answer 1

• 80% arises in clonal expansion of PTH secreting cells within a single gland
• 10-15% of cases 4 gland hyperplasia
• 4% are the product of adenomatous expansion in 2-3 glands

Question 2

Syndromes to exclude

Answer 2

MEN1 (HPT, Pa, Pi, Co, Ca) Wermer’s

• PHPT (100%)
• Pancreas, gastrin, insulin, vip, somatostat, glucagonomes
• Prolactine
• Corticosurrenals
• Carcinoid
• Ovary/testicular

MEN2a (HPT, Phep, Thyr) Sipple’s

• Hyperparathyroidism (20%)
• Pheochromocytome (8-60%)
• notalgic paresthesia
• Medullary Thyroid Carcinoma (100%)

FHH familial hypocalciuric hypercalcemia (24h urine, less than 100mg in 24h is diagnostic)

Question 3

Diagnosis

Answer 3

high blood calcium
low blood phosphate
high intact PTH

exclude :

• thiazidic
• hypoalbuminemia
• low Vitamin D

if Vit D low, substitute and repeat

Question 4

Indication

Answer 4

Symptomatic
Asymptomatic with :
- Hypercalcemia
- > 400mg 24h urinary calcium
- Clearance < 60mL/min or lithiasis
- T Score < -2.5

Question 5

Localisation

Answer 5

Sestamini Spec CT + US (95%) localisation

Question 6

Intra-operative Lab

Answer 6

Intact PTH must fall 50% in 10 minutes

Question 7

Parathyroid Carcinoma

Answer 7

very high Ca and PTH

En bloc resection + thyroid lobe +/- Neck dissection

Question 8

Secondary hyperparathyroidism

Answer 8

PTH resistance due to chronic renal insufficiency or low vitamin D
Not enough calcitriol is synthetized.
Seldom :
- alimentary not enough calcium, too much phosphorous
- paraneoplasic

Question 9

Recurrence

Answer 9

Differentiate between recurrence and persistence
- Redo US + Sestamibi PETCT
MRI T2 including mediastinum