Hyperparathyroidism: primary/secondary/tertiary

Question 1

Define hyperparathyroidism

Answer 1

When excess PTH is produced

Question 2

Describe the epidemiology of hyperparathyroidism

Answer 2

• More common in women
• In the US, 100,000 people are diagnosed every year
• Primary: affects 0.1% of population

Question 3

Explain the causes of primary/secondary and tertiary hyperparathyroidism

Answer 3

• Primary: due to a benign tumour on the parathyroid gland producing excess PTH
• Secondary: get physiological compensatory hypertrophy of glands due to vitamin D deficiency or chronic renal failure (or Crohn’s)
• Tertiary: due to hyperplasia of parathyroid glands AFTER secondary hyperparathyroidism

Question 4

Describe the pathology of hyperparathyroidism

Answer 4

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Question 5

What are the main signs and symptoms of hyperparathyroidism

Answer 5

• Stones: renal colic from renal stones + biliary stones
• Thrones: constipation and acid reflux
• Groans: abdominal pain
• Bones: osteoporosis/painful bone condition (normally osteitis fibrosa cystica)
• Psychiatric undertones: fatigue/anxiety/depression

Signs:

• Hypertension
• Fractures/pain/osteoporosis caused by bone resoprtion

Question 6

Describe the investigations and diagnosis for hyperparathyroidism

Answer 6

1. ) Blood tests will show:
   - Primary: HIGH PTH + HIGH Ca2+ + LOW phosphate
   - Secondary: HIGH PTH + LOW Ca2+ + HIGH phosphate (this due to real disease)
   - Tertiary: HIGH PTH + HIGH Ca2+ + HIGH phosphate
2. ) Increased 24 hour urinary calcium excretion
3. ) DEXA bone scan for osteoporosis
4. ) Abdo X-ray: shows renal calculi or nephrocalcinosis
5. ) Radioisotope scanning - 90% sensitive for detecting adenomas

Question 7

What are the treatment and management options for hyperparathyroidism

Answer 7

• Primary: benign tumour is surgically removed
• Secondary: treat underlying cause - give vitamin D or a kidney transplant
• Tertiary - surgically remove some of the parathyroid tissue to leave enough for PTH to be at normal levels

Emergency:

1. ) Rehydrate with IV 0.9% to prevent stones
2. ) Give bisphosphonates (prevent bone resorption): IV PAMIDRONATE
3. ) Measure serum U&E’s daily

Question 8

What are the treatment and management options for hyperparathyroidism

Answer 8

• Primary:
• parathyroid adenoma is surgically removed
• parathyroid hyperplasia: 4 glands removed
• Give calcimietic to increase sensitivity of PTH to a2+ secretions e.g. oral cinacalcet
• Avoid diuretics + high Ca2+/vit D intake
• Secondary: treat underlying cause - give vitamin D or a kidney transplant
• Tertiary - surgically remove some of the parathyroid tissue to leave enough for PTH to be at normal levels

Emergency:

1. ) Rehydrate with IV 0.9% to prevent stones
2. ) Give bisphosphonates (prevent bone resorption): IV PAMIDRONATE
3. ) Measure serum U&E’s daily