HyperPTH

Question 1

Primary

Answer 1

1) usually adenoma
2) hypercalcemia,
3) hypercalciuria (renal stones)
4) hypophospho
5) high PTH
6) high alk phos
7) cAMP in urine

Often asymptomatic, presents with weakness and constipation (groans)

“Stone, bones, groans”

Question 2

Osteitis fibrosa cystica

Answer 2

Associated with primary hyperPTH

Cystic bone space filled with brown fibrous tissue (bone pain)

Question 3

Secondary

Answer 3

1) 2nd hyperplasia due to low gut Ca2+ absorption and high phosphate.
2) Most often in chronic renal disease (hypovitaminosis D, thus low Ca2+ absorption)
3) Hypocalcemia, hyperphosphatemia in chronic renal failure (hypophospatemia with most other causes)
4) Increased alk phos, PTH

Question 4

Tertiary

Answer 4

Refractory (autonomous) hyperPTH
resulting from chronic renal disease

PTH elevated x2,
Ca2+ elevated

Question 5

Renal osteodystrophy

Answer 5

Bone lesions due to 2’ or 3’ hyperPTH due in turn to renal disease