Hyperparathyroidism

Question 1

Primary - one […] gland (or more) produces […] PTH. This may be asymptomatic or can lead to […]

Secondary - there is increased secretion of […] in response to […] […] because of kidney, liver, or bowel disease.

Tertiary - there is […] secretion of […], usually because of […] […] […] (CKD).

Answer 1

Primary - one parathyroid gland (or more) produces excess PTH. This may be asymptomatic or can lead to hypercalcaemia

Secondary - there is increased secretion of PTH in response to low calcium because of kidney, liver, or bowel disease.

Tertiary - there is autonomous secretion of PTH, usually because of chronic kidney disease (CKD).

Question 2

Causes of primary hyperparathyroidism

Parathyroid gland […] ([…] gland)
Hyperplasia of all […] glands
[…] adenomas
Parathyroid […] (rare)

Answer 2

Causes of primary hyperparathyroidism

Parathyroid gland adenoma (single gland)
Hyperplasia of all four glands
Two adenomas
Parathyroid carcinoma (rare)

Question 3

Signs of hypercalcaemia

Answer 3

Moans, Stones, Groans and Psychiatric Moans

Painful Bones
Renal Stones
Abdominal Groans - GI symptoms: Nausea, Vomiting, Constipation, Indigestion
Psychiatric Moans – Effects on nervous system: lethargy, fatigue, memory loss, psychosis, depression

Question 4

Causes of secondary hyperparathyroidism

1. Vitamin […] deficiency
2. Loss of […] calcium
   - Pancreatitis
   - Rhabdomyolysis
   - Hungry bone syndrome
3. Calcium […]
4. Abnormal […] hormone activity
   - Chronic […] disease
   - Pseudohypoparathyroidism
5. Inadequate calcium intake

Answer 4

Causes of secondary hyperparathyroidism

Vitamin D deficiency
Loss of extracellular calcium
- Pancreatitis
- Rhabdomyolysis
- Hungry bone syndrome
Calcium malabsorption
Abnormal parathyroid hormone activity
Chronic kidney disease
Pseudohypoparathyroidism
Inadequate calcium intake

Question 5

Biochemical findings

Calcium - Normal/Low Phosphate- Low
PTH - High
ALP - High

Answer 5

Vitamin D deficiency

Question 6

Biochemical findings

Calcium - High
Phosphate- High
PTH - High
ALP - High

Answer 6

CKD

Question 7

Biochemical findings

Calcium - Low
Phosphate- Low
PTH - High
ALP - Normal

Answer 7

Malabsorption

Question 8

Biochemical findings

Calcium - Low
Phosphate- High
PTH - High
ALP - Normal/high

Answer 8

Pseudohypoparathyroidism

Question 9

Tertiary hyperparathyroidism causes

Usually occurs after prolonged […] hyperparathyroidism
The glands become […], producing excessive […] even after the cause of […] has been corrected.

Answer 9

Tertiary hyperparathyroidism causes

Usually occurs after prolonged secondary hyperparathyroidism
The glands become autonomous, producing excessive PTH even after the cause of hypocalcaemia has been corrected.