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Hyperparathyroidism

(see also: Renal Osteodystrophy; Remodeling of Bone)

Discussion

Labratory Diagnosis of Hyperparathyroidism »

Histology of Hyperparthyroidism »

Radiology of HyperParaThyroidism: Chondrocalcinosis

Clinical Presentation

General

  • recurrent nephrolithiasis, peptic ulcers, mental changes which has led to the phrase: stones, bones, and groans;"
    • lethargy, somnolence, and polydipsia are also nonspecific findings;

Bone

Kidney

  • 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;

Gut

  • 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;

Neuromuscular

  • proximal weakness, easy fatigability, and atrophy of muscles;

Pyschiatric


Treatment

  • 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
      • nephrolithiasis
      • 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

References