Parathyroid adenoma/hyperparathyroidism Flashcards
What is the definition of a parathyroid adenoma/hyperparathyroidism?
Benign tumour of the parathyroid gland. Normally causes primary hyperparathyroidism
What is the pathology of parathyroid adenoma/hyperparathyroidism?
- 4 parathyroid glands situated posterior to the thyroid
- Release PTH in response to negative feedback via Ca2+ levels
- PTH causes ↑ osteoclast activity = release Ca2+ and phosphate from bones = ↑ Vit D
- Parathyroid proliferative disorder
- Proliferation of chief cells or oxyphilic cells
- Can be cystic, some nuclear pleomorphism, haemorrhage, inflammatory cells and fibrosis
What are the risk factors/aetiology of parathyroid adenoma/hyperparathyroidism?
- Post menopausal woman
- Ionising radiation?
- Genetics e.g. MEN (Multiple Endocrine Neoplasia Syndrome)
- Secondary – kidney failure/Vit D deficiency
- Tertiary – chronic kidney disease
What are the signs/symptoms of parathyroid adenoma/hyperparathyroidism?
- Most are asymptomatic
- ‘Bones, stones, abdominal groans and psychic moans’
- Osteoporosis/osteopenia
- Renal calculi
- Muscle weakness/Proximal myopathy
- Fatigue
- Anorexia
- Nausea/vomiting
- Constipation
- Abdominal pain
- Peptic ulcers
- Acute pancreatitis
- Polyuria/polydipsia/dehydration
- Depression/dementia/confusion/memory loss
- Arrhythmias – severe
- Coma/death – severe
What diseases present similarly to parathyroid adenoma/hyperparathyroidism?
- Gland hyperplasia – cause of hyperparathyroidism
- Parathyroid carcinoma – cause of hyperparathyroidism
- Familial benign hypercalcaemia
- Lithium induced hypercalcaemia
- Thyrotoxicosis
- Sarcoidosis
- Paget’s disease of the bone
- Addison’s disease
What investigations are conducted for suspected parathyroid adenoma/hyperparathyroidism?
- ↑ PTH
- ↑ Ca
- ↓ Phosphate
- Plasma albumin adjusted calcium levels
- U&Es
- Vit D
- DEXA scan
- X-Ray – salt and pepper degranulation in the skull, renal calculi
What are the surgical treatments for parathyroid adenoma/hyperparathyroidism?
• Parathyroidectomy – for severely symptomatic patients
What are the pharmacological treatments for parathyroid adenoma/hyperparathyroidism?
- Vitamin D
- HRT – postmenopausal woman
- Raloxifene – postmenopausal woman
- Bisphosphonates
- Cinacalcet - ↓ both Ca and PTH levels
What are the non pharmacological treatments for parathyroid adenoma/hyperparathyroidism?
- Hydration
* Balanced diet
