Hyerparathyroidism Flashcards
define primary hyperparathyroidism?
increased secretion of PTH unrelated to the plasma calcium concentration
define secondary hyperparathyroidism?
increased secretion of PTH secondary to hypocalcaemia
Define tertiary hyperparathyroidism?
autonomous PTH secretion following chronic secondary hyperparathyroidism
what are the causes of primary hyperparathyroidism?
Parathyroid adenoma
Parathyroid hyperplasia
Parathyroid carcinoma
MEN syndrome
Associated with HTN
what are the causes of secondary hyperparathyroidism?
Chronic renal failure
Malabsorption syndromes
Vitamin D deficiency
summarise the epidemiology of hyperparathyroidism?
Primary - incidence of 5/100,000
Twice as common in FEMALES
Peak incidence: 40-60 yrs
what are the risk factors for hyperparathyroidism?
female sex
age ≥50-60 years
family history of PHPT
multiple endocrine neoplasia (MEN) 1, 2A, or 4
what are the signs and symptoms of primary hyperparathyroidism?
REMEMBER STONES, BONES, ABDO GROANS, PSYCHIC MOANS
Polyuria
Polydipsia
Renal calculi
Bone pain
Sleep disturbances
Memory loss
Abdominal pain
Nausea
Constipation
Psychological depression + anxiety
Lethargy
Fatigue
Memory loss
Myalgia
Paraesthesia
what are the symptoms of secondary hyperparathyroidism?
signs and symptoms of hypocalacaemia or signs or uderlying cause ( renal failure, vit D deficiency)
Bruising
Pruritus
Elevated BP
Fatgiue
Nausea
Poor concentration/memory
Tingling in fingers and toes
Myoclonus
Muscle cramps
Bone pain
Chvostek’s sign
Trousseau’s sign
Bowed legs/ knock knees
what are the appropriate investigations for hyperparathyroidism?
U&Es – urea and creatinine high in CKD
Serum calcium (high in h and tertiary, low/normal in secondary)
Serum phosphate (low in primary and tertiary and Osteomalacia due to VitD, high in osteomalacia due to CKD)
Albumin
ALP
Vitamin D
PTH
what can be seen on the x ray in hyperparathyroidism?
what scans may you order in hyperparathyroidism and what may you see on the scan?
x ray
renal ultrasound- visualise renal calculi
outline the management for primary hyperparathyroidism?
Acute Hypercalcaemia
- IV fluids
- bisphosphonates if calcium remains high
- Avoid factors that exacerbate hypercalcaemia (e.g. thiazide diuretics)
- Maintain adequate hydration
- Moderate calcium and vitamin D intake
Surgical Management
- Subtotal parathyroidectomy
- Total parathyroidectomy
- NEED VIT D SUPPLEMENTATION AFTER
If surgery denied or not suitable
- Serum calcium and creatinine should be measured every 12 months
- Avoid meds which increase serum calcium levels (e.g. thiazide diuretics, lithium)
- Bisphosphonates if osteoporosis is present
- Vit D supplementation if neccesary
outlind the management for secondary hyperparathyroidism?
Treat underlying cause (e.g. renal failure)
- Gut Phophate binders e.g. Sevelamer – treats the hyperphosphataemia
Calcium and vitamin D supplements may be needed – only after phosphate levels are lowered
e.g. ergocalciferol
what are the possible complications of primary hyperparathyroidism?
Increased bone resorption => osteoporosis, bone fractures
Increased tubular calcium reabsorption
Increased 1a-hydroxylation of vitamin D
All of these lead to hypercalcaemia
