Please enable JavaScript.
Coggle requires JavaScript to display documents.
Hyperparathyroidism (Clinical presentation (CNS Weakness Confusion …
Hyperparathyroidism
Clinical
presentation
CNS
Weakness
Confusion
Depression
General
Fatigue
Dehydration
Musculoskeletal
Bony pains
Asyptomatic
Abdo
Abdo pain
Renal
Thirst
Polyuria
Renal colic
Pathophysiology
PTH, Ca and phosphate
Primary hyperparathyroidism
Intrinsic defect of parathyroid gland, causing
excess PTH secretion, thus high Ca resorption
E.g. tumour, adenoma or hyperplasia
Secondary hyperparathyroidism
Defect outside parathyroid gland causing low Ca,
with feedback to gland to increase PTH
E.g. CKD, vit D deficiency
Tertiary hyperparathyroidism
Prolonged secondary hyperparathyroidism causes
hyperplasia of parathyroid gland and very high PTH
Ca level increases due to high PTH
E.g. CKD renal transplant (corrected)
Malignant hyperparathyroidism
Secretion of PTH-related protein PTH-rp) by cancers
PTH mimic, high Ca (but low endogenous PTH from negative feedback)
Aetiology
Secondary
Metabolic: low Ca, low Vit D, CKD
Tertiary
Iatrogenic: renal transplant
Primary
Neoplastic: benign adenoma (commonest),
hyperplasia, cancer (rare)
Malignant
Neoplastic: lung, breast, renal cancers
Management
Secondary
Conservative
Information, advice, support
Manage cause
Medical
Vit D
Indication: vit D deficiency
MOA: replacement of deficiency
Phos binders
Indication: hyperphosphatemia
MOA: bind phos, preventing formation
of crystal aggregates i.e. caliculi
Calcimimetics
Indication: high PTH, surgery unsuitable
MOA: inc sensitivity of parathyroid cells
to Ca, thus reducing PTH by -ve feedback
SEs: myalgia, low testosterone
Surgical
Parathyroidectomy
Indication: symptoms/complications
MOA: removal of parathyroid glands
SEs: hypoparathyroidism, recurrent
laryngeal nerve palsy, hypocalcaemia
Tertiary
Medical
Calcimimetics
Indication: high PTH, surgery unsuitable
MOA: inc sensitivity of parathyroid cells
to Ca, thus reducing PTH by -ve feedback
SEs: myalgia, low testosterone
Surgical
Parathyroidectomy
Indication: symptoms/complications
MOA: removal of parathyroid glands
SEs: hypoparathyroidism, recurrent
laryngeal nerve palsy, hypocalcaemia
Conservative
Information, advice, support
Manage cause
Adequate fluid intake
Meds review (avoid thiazides and Li, can inc Ca further)
Primary
Medical
Calcimimetics
Indication: high PTH, surgery unsuitable
MOA: inc sensitivity of parathyroid cells
to Ca, thus reducing PTH by -ve feedback
SEs: myalgia, low testosterone
Surgical
Parathyroidectomy
Indication: symptoms/complications
MOA: removal of parathyroid glands
SEs: hypoparathyroidism, recurrent
laryngeal nerve palsy, hypocalcaemia
Conservative
Information, advice, support
Adequate fluid intake
Meds review (avoid thiazides and Li, can inc Ca further)
Review 6m (FBC, U+E. LFT, bone profile, BP)
Malignant
Conservative
Information, advice, support
Manage cause (i.e. cancer)
Adequate fluid intake
Meds review (avoid thiazides and Li, can inc Ca further)
Surgical
Parathyroidectomy
Indication: symptoms/complications
MOA: removal of parathyroid glands
SEs: hypoparathyroidism, recurrent
laryngeal nerve palsy, hypocalcaemia
Complications
Gastrointestinal
Peptic ulcers (DUs)
Pancreatitis
Musculoskeletal
Osteoporosis, fractures
Renal
Caliculi
Cardiovascular
HTN
Epidemiology
Commonest cause of hyper-Ca
Onset usually 50-60y
F>M
Diagnosis
Examination
Abdo exam
Dehydration, abdo pain
Neuro exam
Redcued GCS
Cardio exam
HTN
Investigations
Bloods
FBC, U+E, LFT, TFT,
Ca (high in primary, tertiary and malignant; low in secondary)
PTH (high in primary, secondary and tertiary; low in malignant)
Bone markers (phos low, ALP high)
Urine
High Ca
Bedside
Obs (HTN)
Imaging
USS KUB (renal caliculi)
X-rays (osteitis fibrosis cystica,
erosions, cysts, pepper pot skull)
CXR (lung cancer)
DEXA (osteoporosis)
History
DH
Meds, allergies
FH
Parathyroid disease,
cancers
PMH
Known medical conditions (CKD)
Previous/current cancers
SH
Living arrangements, occupation,
smoking, alcohol, diet
PC/HPC
Vague non-specific symptoms,
fatigue, dehydration,
confusion, thirst, polyuria,
abdominal pain, bony pain
Definition
Endocrine disorder of
excessive and inappropriate
PTH secretion
