what are the causes of primary hyperparathyroidism?
Causes of primary hyperparathyroidism 80%: solitary adenoma 15%: hyperplasia 4%: multiple adenoma 1%: carcinoma
what are the symptoms?
symptoms of Hypercalcaemia-> bones, stones, abdominal groans and psychiatric moans
- polyuria and polydipsia
- depression
- anorexia, nausea nad consitpation
- peptic ulceration
- bone pain and fractures-> due to osteopenia
- pancreatitis
- renal stones
- hypertension
which diseases are associated with primary hyperparathyroidism?
hypertension
multiple endocrine neoplasia: MEN I and II
what will investigations for primary hyperparathyroidism show?
- raised calcium, low phosphate
- PTH may be raised or (inappropriately, given the raised calcium) normal
- pepperpot skull is a characteristic X-ray finding of hyperparathyroidism
what is the definitive management for primary hyperparathyroidism?
total parathyroidectomy
what is the conservative management for primary hyperparathyroisim?
- this may be offered to patients with calcium >0.25 the upper limit of normal and >50 yrs with no evidence of end organ damage
- tx with cincalcet or calcimimetic
how does calcimimetic work?
mimics the action of calcium by allosteric binding of calcium sensing receptors
what are the common causes of secondary hyperparathyroidism?
- CKD and Vit D deficiency because they reduce absorption of calcium
- this leads to parathyroid glad hyperplasia
- the hyperplasia will resolve if the kidney disease and vitamin D deficiency are resolved
what are the complications of parathyroidectomy?
- Hypocalcaemia: there may be rebound hypocalcaemia following surgery
- Recurrent laryngeal nerve injury: following removal of the parathyroid glands
- Post-operative haematoma: may require evacuation
what will bloods for secondary hyperparathyroidism look like?
- calcium low or normal
- parathyroid hormone high
- vit D low
- phosphate can be high or low
