Hyperparathyroidism

• What would you see in the bloods for primary hyperparathyroidism?

  Raised PTH

  Raised calcium

  Raised ALP

  Low phosphate
• What would you see in the bloods for tertiary hyperparathyroidism?

  High PTH

  High ALP

  High calcium

  Normal phosphate/vit D
• What would you see in the bloods for secondary hyperparathyroidism?

  High PTH

  High phosphate

  Low calcium

  Normal ALP

  Low vit D
• What may cause primary hyperparathyroidism?

  Solitary parathyroid adenoma
• What happens in primary hyperparathyroidism?

  Excess PTH secretion -> hypercalcaemia
• What usually causes primary hyperparathyroidism?

  Parathyroid adenoma
• What happens in secondary hyperparathyroidism?

  CKD/ insuffucuent vit D -> dec calcium absorption
• What causes tertiary hyperparathyroidism?

  Secondary continues for a while -> hyperplasia of glands
• What happens in tertiary hyperparathyroidism?

  Hypocalcaemia -> inc PTH production (overshoots) = hypercalcaemia
• What are some risk factors for hyperparathyroidism?

  HTN

  Multiple endocrine neoplasia
• What are some key symptoms of hyperparathyroidism? (bones, stones, groans and psychic moans)

  Bones - Bone pain/fracture

  Stones - Renal stones

  Groans - Nausea, anorexia, constipation, peptic ulcers, pancreatitis

  Psychic moans - Depression, fatigue, psychosis
• What are some first-line investigations for hyperparathyroidism?

  Serum calcium

  Parathyroid hormone

  KFTs

  Vit D levels
• What is the hallmark of primary hyperparathyroidism?

  Hypercalcaemia
• In those with hyperparathyroidism, who is a parathyroidectomy indicated in?

  Symptomatic disease

  <50 years old

  Serum adjusted calcium of >2.85 mmol/L

  eGFR of <60
• When parathyroid surgery is not acceptable how is hyperparathyroidism managed?

  Calcitonin (inhibits bone and kidney reabsorption of calcium)

  Calcimimetic (cinacalcet)

  Desunomab

  Bisphosphonates
• hat may be seen on a head CT for hyperparathyroidism?

  Pepper pot skull appearance