Hyperparathyroidism

Question 1

an investigation

how to differentiate between 1ry hyperparathyroidism and familial hypocalciuric hypercalcemia?

Answer 1

urinary calcium

but low in FHH

is high in hyper para

Question 2

FAMILIAL hypercalciuric hypercalcemia

Answer 2

benign
young pt
asymptomatic
MILDLY elevated calcium
norm/low PTH

Question 3

Bisphosphonates

Answer 3

inhibit osteoclast activity

Question 4

most likely gene behind hyperparathyroidism

Answer 4

MEN i (parathyroid adenoma, pancreatic endocrine tumors, pituitary adenoma)

Question 5

hyperparathyroidism is more common with which MEN I OR II

Answer 5

MEN I

MEN I 90%

MEN I 90%
MEN II 20-30%

Question 6

What are 1ry Brown tumors?

Answer 6

lytic bone lesions due to excessive osteoclast activity from hyperparathyroidism

Question 7

after total Parathyroidectomy:

hungry bone syndrome

Answer 7

when the hormone driving the osteoclats (PTH) is removed, there is shift towards osteoblastic activity consuming the serum calcium in its wake> hypocalcemia > hungry bone syndrome

Question 8

pathognomonic X-ray finding in Hyperparathyroidism

Answer 8

Sub-periosteal bone resorption
>irregular lace like appearance

Question 9

when is conservative mng the ttx of choice in 1ry hyperpara?

Answer 9

1. if ca2+ is <0.25 mmol/L above the ULN
2. > 50 YEARS OLD
3. No evidence of end-organ damage