Hyperparathyroidism

• Hyperparathyroidism


  Refers to raised parathyroid hormone
• Parathyroid glands


  Four glands situated in four corners of the thyroid gland
• Chief cells


  Cells in the parathyroid glands that produce parathyroid hormone in response to hypocalcaemia (low blood calcium)
• Parathyroid hormone actions


  1. Increasing osteoclast activity in bones (reabsorbing calcium from bones)

  2. Increasing calcium reabsorption in the kidneys (less calcium is lost in urine)

  3. Increasing vitamin D activity, resulting in increased calcium absorption in the intestines
• Vitamin D


  Acts to increase calcium absorption from the intestines
• Parathyroid hormone and vitamin D

  Raise blood calcium levels
• Symptoms of Hypercalcaemia


  • Kidney stones
  • Painful bones
  • Abdominal groans (constipation, nausea and vomiting)
  • Psychiatric moans (fatigue, depression and psychosis)
• Types of Hyperparathyroidism


  • Primary hyperparathyroidism
  • Secondary hyperparathyroidism
• Primary hyperparathyroidism is caused by uncontrolled parathyroid hormone production by a tumour of the parathyroid glands, leading to raised blood calcium (hypercalcaemia). Treatment is to remove the tumour surgically
• Secondary hyperparathyroidism is where there is insufficient vitamin D or chronic...
• Hyperparathyroidism is caused by uncontrolled parathyroid hormone production by a tumour of the parathyroid glands, leading to raised blood calcium (hypercalcaemia). Treatment is to remove the tumour surgically
• Secondary hyperparathyroidism is caused by insufficient vitamin D or chronic kidney disease, resulting in low blood calcium (hypocalcaemia). The parathyroid glands react by excreting more parathyroid hormone. The serum calcium level will be low or normal, but the parathyroid hormone will be high. Treatment is to correct the underlying vitamin D deficiency or chronic kidney disease (e.g., renal transplant)
• Tertiary hyperparathyroidism occurs when secondary hyperparathyroidism continues for an extended period. Hyperplasia of the parathyroid glands occurs as they adapt to producing a higher baseline level of parathyroid hormone. Treatment involves surgically removing part of the parathyroid tissue to return the parathyroid hormone to an appropriate level
• Primary hyperparathyroidism cause


  Tumour
• Primary hyperparathyroidism PTH level

  High
• Primary hyperparathyroidism Calcium level

  High
• Secondary hyperparathyroidism cause


  Low vitamin D or CKD (chronic kidney disease)
• Secondary hyperparathyroidism PTH level

  High
• Secondary hyperparathyroidism Calcium level

  Low/Normal
• Tertiary hyperparathyroidism cause


  Hyperplasia
• Tertiary hyperparathyroidism PTH level

  High
• Tertiary hyperparathyroidism Calcium level

  High
• Last updated


  March 2023