Hyperparathyroidism

Question 1

When is parathyroid hormone produced?

Answer 1

In response to low calcium

Question 2

Vitamin D and parathyroid hormone decrease calcium levels. True/false?

Answer 2

False, both vitamin D and parathyroid hormone act to increase calcium levels.

Question 3

What phrase can be used to remember the symptoms of hypercalcaemia (high calcium)?

Answer 3

Stones, bones, moans and abdominal groans.

Kidney stones

Painful bones

Psychiatric moans i.e. fatigue, depression etc.

Abdominal moans i.e. nausea, vomiting, constipation etc.

Question 4

What is primary hyperparathyroidism?

Answer 4

Uncontrolled parathyroid hormone production caused by tumour in parathyroid glands (most commonly parathyroid adenoma). Treatment is to remove the tumour.

Question 5

What is secondary hyperparathyroidism?

Answer 5

Insufficient vitamin D or CKD reduces calcium reabsorption from the kidneys, intestines and bones.

Leads to reduced calcium in blood, parathyroid glands try to compensate by producing excess hormone.

Question 6

What is tertiary hyperparathyroidism ?

Answer 6

This is when secondary hyperparathyroidism carries on for an extended period of time, after the underlying cause is treated, there is a new baseline for the parathyroid hormone.

When underlying cause is solved, the high baseline parathyroid hormone can then cause hypercalcaemia due to increased calcium reabsorption from bones, kidneys and intestines.

Question 7

Primary hyperparathyroidism causes and values?

Answer 7

Tumour (commonly parathyroid adenoma - benign)
High PTH and high calcium

Question 8

Secondary hyperparathyroidism causes and values?

Answer 8

Low vitamin D and CKD
High PTH and low/normal calcium

Question 9

Tertiary hyperparathyrodism causes and values?

Answer 9

Hyperplasia (increase in tissue due to cell proliferation)
High PTH and High calcium