Hyperparathyroidism

more about Hyperparathyroidism

Description

Normal

Abnormal

• The parathyroids are a set of four tiny glands located inside the thyroids, separate from the thyroids in structure and function.  They secrete Parathyroid hormone, involved in maintaining Calcium levels in the blood.

• Hyperparathyroidism refers to a condition in which these glands produce excess Parathyroid hormone, resulting in elevated levels of Calcium associated with “leaching” Calcium from the bones.

Symptoms

• Often none if mild
• Kidney Stones
• Back pain
• Joint pain
• Increased urination
• Increased thirst
• Loss of appetite
• Abdominal pain
• Nausea/vomiting
• Stomach ulcer
• Constipation
• Weight loss
• High Blood Pressure
• Muscle weakness
• Depression
• Psychosis
• Itching

• Numbness/tingling

Cause

• Hyperplastic (overgrown) parathyroid glands
• Parathyroid adenoma (benign tumor)
• Parathyroid cancer (rare)

• Multiple neoplasm syndromes

How the diagnosis is made

• Calcium and Parathyroid hormone serum levels are elevated, and the Phosphorus blood level is low.
• Make sure there is no lab error (e.g., high albumin level or Dehydration present to artificially raise Calcium level)
• 24-hour urine Calcium excretion may be high or normal and Phosphorus excretion high.
• Imaging — no imaging technique is ideal.  MRI, CT scan, Nuclear scan, and Ultrasound may all be considered.  Often do not know diagnosis until surgery.

• X-Rays of bones may show diffuse demineralization.

Treatment

• Severe Hypercalcemia — acute treatment:

1. 1. Intravenous saline with Lasix
   2. Pamidronate
   3. Corticosteroids for Vitamin D intoxication and Sarcoidosis

• Mild cases (i.e., Calcium level <11.0 mg/dL)

1. 1. Large fluid intake.
   2. Avoid thiazide diuretics and bed rest
   3. Phosphorus supplementation if kidney function is normal, but phosphate binders may be needed if kidney function is not normal
   4. Estrogen supplementation for post-menopausal women

• Severe cases:

– Surgical exploration and removal. Careful management of Calcium and Phosphorus levels post-operatively (they may drop very low).

Complications

• Pathologic bone fractures
• Urinary Tract Infections
• Kidney Stones
• Kidney failure (renal osteodystrophy)
• Stomach ulcer
• Pancreatitis
• Pseudo-gout

• Hypocalcemia in neonate

Similar Conditions

• Malignant tumors may secrete substance similar to Parathyroid hormone
• Multiple Myeloma
• Burkitt’s Lymphoma
• Sarcoidosis
• Excess Calcium ingestion
• Excess vitamin D ingestion
• Familial hypocalciuric Hypercalcemia
• Adrenal insufficiency
• Hyperthyroidism
• Bone fractures
• Acute kidney failure
• Vitamin A toxicity

• Paget’s disease