Parathyroid disease (hyperparathyroidism)

Question 1

Aetiology/ Risk factors: What are the causes of parathyroid disease (hyperparathyroidism)? (3)

Answer 1

• Adenoma (most common)
• Hyperplasia (common is secondary hyperparathyroidism)
• Parathyroid cancer (rare)

Question 2

Symptoms and signs: What are the clinical features associated with parathyroid disease? (a lot)

Answer 2

• Painful stones
• Aching bones (bone pain)
• Psychic moans
• Abdominal groans (abdominal pain)
• Constipation
• Polyuria (due to calcium deposition in the renal tubules)
• Renal calculi
• Renal failure
• Pancreatitis
• Peptic ulceration
• Weight loss
• Depression
• Confusion
• Paranoia

Question 3

Investigations: How do we investigate a patient with parathyroid disease?

Answer 3

• Bloods (U+E, creatinine, calcium, phosphate, parathyroid hormone, bicarbonate)
• Vitamin D
• Ultrasound
• CT/MRI (to identify ectopic glands)
• Isotope scanning (detects diseased glands)

Question 4

Treatment: How do we treat a patient with parathyroid disease (hyperparathyroidism)?

Answer 4

• Surgery (to remove the affected parathyroid glands)

Question 5

Extra: Where are the 4 parathyroid gland situated

Answer 5

• The 4 parathyroid glands situated posterior to the thyroid regulate calcium and phosphate levels

Question 6

Extra: What does a high level of parathyroid hormone do to serum calcium and serum phosphate levels?

Answer 6

• High levels of PTH cause serum calcium levels to increase and serum phosphate levels to fall

Question 7

Extra: What happens in secondary hyperparathyroidism?

Answer 7

• In secondary hyperparathyroidism, there is increased secretion of PTH in response to low calcium because of kidney, liver, or bowel disease.