• PTH overproduction induced by hypocalcemia.
• PTH serum H, Ca serum L, P serum H-renal /L-vit.D, ALP serum H Ca urine L
• Caused by chronic renal failure (most common cause), as well as vitamin D de ciency and renal hypercalciuria.

• secondary to long standing secondary hyperparathyroidism, characterised by development autonomous hypersecretion of PTH causing hypercalcemia.
• PTH serum H, Ca serum H, P serum H, ALP serum H, Ca urine various

• group of sings and symptoms related to overproduction of PTH not caused by impaired mineral imbalance ( ca & p) resulting in abnormal ca & p homeostasis.
• PTH serum H, Ca serum H, P serum L, ALP serum H, Ca urine H

• aetiology:
  85 % - parathyroid adenoma,
  15 %- parathyroid hyperplasia of all 4 glands,
  < ,5 % - parathyroid carcinoma.

• symptoms:
  80% asymptomatic,
  20% systemic: classical ( related to hypercalcemia, urinary [ nephrolithiasis { recurrent, bilateral, calcium oxalate}, polyuria, polydipsia, chronic renal failure due to cacinosis], osseous system [subperiosteal resorption, osteoporosis, osteopenia, soul 'salt and pepper', brown bone, pathologic fracture, phalangeal tuff resorption, osteitis fibrous cystica (“brown tumors”)]), GI [peptic ulcer, pancreatitis, constipation, vomiting, loss of appetite] , CVS [tachycardia, arrhythmia, short qt interval, hypertension], CNS [ headache, sleepless, psychosis, confusion], anaemia, glucose intolerance, ca in tissue, band keratopathy- ca in horizontal band in the cornea.

• DD:
  -neurofibromatosis type 1 (NF1);
  criteria ( 2 or more): 6 or more cafe au lait spots, 2 or more neurofibromas, freckling in axilla or groin, optic glioma, 2 or are lisch nodule (iris hamartomas), bony lesion (dysplasia of the sphenoid bone or dysplasia or thinking of long bone cortex),
  -osteitis deformano ( paget's disease),
  -bone neoplasms

• lab: UP.
• imaging: Tc 99- gold standard, MRI, ct, hires ultrasund.mipi
  

non-surgical:

• observation:
  ca <12 mg%,
  diet should have 800-100 mg of calcium per day,
  avoid thiazides
• pharmacological: sever hyperca. - Ca > 14 mg% or > 12 mg% + symptoms:
  increase calciuresis: .9 nacl iv.- 2-4 l/d, furosemide 10-20 mg
  decrease bone resorption: pamidronic acid, zoledronic acid, klodronic acid, calcitonin 400-8-- iu iv.
  decrease vit.d activation: hydrocortisone.

surgical:

• absolute:
  "classical" symptoms,
  ca serum > 12, ca urne >400 mg/24h, bmd score <-2.0 sd,
  pancreatitis, neuromuscular disorder.
• relative: age <50, progressive renal damage, progressive meant disturbances.

• Most common cause of hypercalcemia,
• can occur as part of MEN,