Hyperparathyroidism

Question 1

Causes of hypercalcaemia?

Answer 1

• Medications (e.g., calcium and vitamin D supplements)
• Hyperparathyroidism
• Cancer ( esp. lung, breast and kidney)
• Renal failure with reduced calcium excretion

Question 2

How to treat hypercalcaemia caused by cancer? Mechanism of action?

Answer 2

SC or IM calcitonin
Inhibits osteoclast activity and calcium reabsorption in the kidneys

Question 3

What is primary hyperparathyroidism?

Causes?

Answer 3

Overproduction of parathyroid hormone by parathyroid gland

Tumour of parathyroid gland

Question 4

Management of primary hyperparathyroidism

Answer 4

Medical: Cinacalcet
Surgery

Question 5

What is secondary hyperparathyrodism

Answer 5

High PTH due to…
Vitamin D deficiency or CKD
causes hypocalcaemia -> PT gland compensates by producing too much PTH

Question 6

What is tertiary hyperparathyroidism

Answer 6

High PTH due to…
Secondary hyperparathyroidism even after correction of vit D/CKD as PT hormones have undergone hyperplasia and continues secreting too much PTH

Question 7

Symptoms of hypercalcaemia?

Answer 7

‘STONES, BONES, GROANS, MOANS’

Kidney stones (Stones)

Bone pain (bones)

Constipation, N+V (groans)

Fatigue, depression, psychosis (moans)

Question 8

What is the role of Calcitonin?

Answer 8

Opposes action of Parathyroid hormone decreasing serum calcium

Inhibits osteoclast activity (bone breaking)

Activates osteoblast activity (bone building)

Inhibits GIT absorption of calcium

Inhibits reabsorption of calcium from kidney tubules