- Renal Osteodystrophy:
- Remodeling of Bone
- caused by excessive production of parathyroid hormone which leads to hypercalcemia, recurrent nephrolithiasis, pancreatitis, peptic
ulcers, and mental changes;
- incidence of approx 5 /10,000 pts per year;
- usually affects adults over 50 yrs & occurs more commonly in females;
- in most cases is due to single parathyroid adenoma (80% of patients);
- malignant tumor: occurs in about 1% of patients with hyperparathyroidism;
- occurs often in association w/ multiple endocrine neoplasia syndrome, and rarely to parathyroid carcinoma;
- hyperparathyoidism is sometimes seen in renal cell carcinoma and squamous cell carcinoma;
- diff dx:
- occult tumor;
- multiple myeloma (often associated w/ hypercalcemia);
- primary defect of the parathyroid gland w/ hypersecretion of PTH as seen w/ adenoma's of the parathyroid gland;
- secondaray causes arise from conditions that produces abnormally low ionic plasma Ca levels and thereby stimulates
production of PTH (see renal disease: effects on bone):
- tertiary conditions in which PTH secretion has become autonomous after prolonged stimulation of gland owing
to secondary parathyroidism;
- Primary hyperparathyroidism: incidence, morbidity, and potential economic impact in a community.
- Pathology of the parathyroids in hyperparathyroidism. Discussion of recent advances in pathology of the parathyroid glands.
- Recent advances in parathyroid gland pathology.
- Primary hyperparathyroidism: changing patterns in presentation and treatment decisions in the eighties.
- Labratory Diagnosis of Hyperparathyroidism
- Histology of Hyperparthyroidism:
- Radiology of HyperParaThyroidism: Chondrocalcinosis
- Clinical Presentation:
- recurrent nephrolithiasis, peptic ulcers, mental changes which has led to the phrase: stones, bones, and groans;"
- lethargy, somnolence, and polydipsia are also nonspecific findings;
- PTH mobilizes bone and phosphate;
- releases osteocytic perilacunaar stores (fast)
- increases osteocytic number and activity (slow)
- activates & increases number of osteoclasts, which leads to osteomalacia and more acutely, releases Ca & Phos;
- causes diffuse bone pain and tenderness;
- stimulate bone remodeling, w/ increase in number of BMU;
- brown tumor;
- chondrocalcinosis and calcific periarthritis are common (ossification of soft tissue);
- fractures secondary to diffuse skeletal osteoporosis;
- NEJM: pseudoclubbing: images in medicine
- Fractures of the femoral neck in elderly patients with hyperparathyroidism.
- Joint lesions of hyperparathyroidism.
- Osteosclerosis in primary hyperparathyroidism.
- Hyperparathyroidism: tumor of the parathyroid glands associated with osteitis fibrosa.
- Parathyroid hormone and bone.
- A case of multiple skeletal lesions of brown tumors, mimicking carcinoma metastases
- increases resorption of calcium;
- increases excretion of phosphate;
- stimulates 1,25 (OH)2 vit D3 (calcitriol) production;
- common occurrence of renal calculi (in untreated cases, calculi sometimes caused renal failure);
- increase renal phosphate excretion by decreasing renal tubular reabsorption of phosphate;
- increases absorption thru vitamin D;
- acting at level of gut (w/ vit D) to incr absorption of calcium;
- gastric ulcers (seen in 25% of patients) & pancreatitis are common;
- pancreatic calcifications;
- proximal weakness, easy fatigability, and atrophy of muscles;
- individuals w/ serum Ca level of > than 12 mg/dl (2.99 mm/lit) (see hypercalcemia) have mental aberrations, confusion,
- Neuropsychologic deficits associated with primary hyperparathyroidism.
- non operative treatment includes adequate calcium intake and avoidance of Vit D;
- w/ vague constitutional symptoms such as fatigue, weakness, and/or constipation associated w/ mild hypercalcemia then
surgery is not indicated;
- note that in most patients w/ primary hyperparathyroidism there is little if any disease progression;
- among asymptomatic patients, approximately 25 % will have progressive disease, which can be measured as a signficant
decrease in bone mass over a decade;
- operative treatment indications:
- surgical treatment is indicated when clinical symptoms occur along with laboratory or radiographic abnormalities;
- clinical findings:
- osteitis fibrosa cystica
- classic neuromuscular symptoms (proximal muscle weakness, atrophy, hyperreflexia, and gait disturbances);
- hyperparathyroid crisis (a discrete episode of life-threatening hypercalcemia);
- laboratory and radiographic data;
- serum calcium concentration of greater than 12 mg per deciliter (3 mmol per liter)
- marked hypercalciuria (urinary calcium excretion, greater than 400 mg per day [10 mmol per day])
- markedly reduced cortical bone density (z score for the distal third of the radius, less than -2;
- z score: standard deviation from mean for sex-matched and age-matched reference population), an unexplained
reduction in Cr clearance
Fractures of the femoral neck in elderly patients with hyperparathyroidism.
Joint lesions of hyperparathyroidism.
Osteosclerosis in primary hyperparathyroidism.
Hyperparathyroidism: tumor of the parathyroid glands associated with osteitis fibrosa.
Parathyroid hormone and bone.
A 10-Year Prospective Study of Primary Hyperparathyroidism with or without Parathyroid Surgery.
Original Text by Clifford R. Wheeless, III, MD.
Last updated by Data Trace Staff on Friday, December 2, 2016 9:05 am