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Hyperparathyroidism – Quick revision card

Hyperparathyroidism – excess production of parathyroid hormone.

Primary hyperparathyroidism – Hypercalcemia with elevated or inappropriately normal conc of PTH
 Most commonly due to a benign overgrowth of parathyroid tissue 
( adenoma) in a single gland ( in 80 % 
cases ) or as a multiple gland disorder. The problem is in the gland. A common disorder which can cause significant renal and skeletal complications.

 

Persistent hypercalcemia and an elevated PTH. Exceptions are if the patient is on thiazide diuretics , lithium excess , 24 hr urinary calcium and creatinine excretion can be used further in evaluation particularly to r/o a rare condition familial hypocalciuric hypercalcemia.

 

Happens due to the result of a physiological or pathophysiologic response to hypocalcemia in an attempt to maintain calcium balance, for e.g in circumstances as
 vitamin D deficiency Chronic renal failure and the resulting alterations in Vit D , phosphorus and calcium

 

Any condition causing hypocalcemia or Vitamin D deficiency can lead to secondary hyperparathyroidism
The problem is extrinsic.

 

Diagnosis based on clinical presentation and metabolic derangement. Assessment consists of monitoring the values of PTH , calcium , phosphorus , VIt D & renal function.

 

Tertiary hyperparathyroidism – Less common A progression from long standing secondary hyperparathyroidism A field of specialists – mostly seen in the setting of chronic renal failure
( the gland is functioning autonomously from the normal negative feedback response )

REFERENCES

  1. Muppidi V, Meegada SR, Rehman A. Secondary Hyperparathyroidism. [Updated 2021 Sep 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557822
  2. Pokhrel B, Levine SN. Primary Hyperparathyroidism. [Updated 2021 Jul 21]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441895/
  3. Bilezikian JP, Bandeira L, Khan A, Cusano NE. Hyperparathyroidism. Lancet. 2018 Jan 13;391(10116):168-178. doi: 10.1016/S0140-6736(17)31430-7. Epub 2017 Sep 17. PMID: 28923463. ( Abstract )
  4. Taniegra ED. Hyperparathyroidism. Am Fam Physician. 2004 Jan 15;69(2):333-9. PMID: 14765772.
  5. Pathophysiology of Parathyroid Glands Jason Smith et al Thyroid and Parathyroid diseases

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