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Clinical Skills Blogspot

Hyperparathyroidism

Title               

Ñ    Hyperparathyroidism

Definition

Ñ    Metabolic state caused by excess parathyroid hormone

Pathogenesis

Causes

Primary hyperparathyroidism

Ñ    Adenoma (single or multiple):

May be part of MEN 1

Ñ    Carcinoma

Ñ    Hyperplasia of the parathyroid gland:

May be part of MEN 2A

Secondary hyperparathyroidism

Ñ    Physiological response to hypocalcaemia

Tertiary hyperparathyroidism

Ñ    Autonomous functioning of parathyroid tissue following secondary hyperparathyroidism

Pseudohyperparthyrpoidism

Ñ    Ectopic production of PTH like substances from malignant tissue especially lung

Pathophysiology

Ñ    Increased physiological effects of parathyroid hormone

Clinical Features

History

Ñ    Mild hypercalcaemia is usually asymptomatic:

< 3.0 mmol/L

E&M

Ñ    Tiredness

Ñ    Malaise

GIT

Ñ    Abdominal pain

KUS

Ñ    Renal colic

Ñ    Polyuria

CNS

Ñ    Depression

LMS

Ñ    Bone pain

Examination

IS

Ñ    Decreased skin turgor:

Salt and water loss

CVS

Ñ    Postural drop in blood pressure:

Salt and water loss

CNS

Ñ    Corneal calcification:

Marker of long-standing hypercalcaemia

LMS

Ñ    Chondrocalcinosis

Investigations

Fluids

Blood

Biochemistry

Ñ    Hypercalcaemia

Ñ    Phosphate:

Low

Ñ    PTH:

Elevated

Ñ    Hyperchloraemic acidosis:

Mild

Imaging

Abdominal X-Ray

Ñ    Renal calculi

Ñ    Nephrocalcinosis

X-ray Hands

Ñ    Subperiosteal erosions

Ultrasound

Ñ    Not sensitive for small tumours

High resolution CT

Ñ    Image tumour

MRI

Ñ    Image tumour

Nuclear Medicine

^99m Tc Sestambi scanning

Ñ    Demonstrate tumour

Physiological studies

Catheterisation of neck veins and measure PTH levels

Ñ    Localise tumour

Management

Control

Drugs

Ñ    Emergency treatment of hypercalcaemia:

·          Saline infusion:

Rehydration

·          Intravenous bisphosphonates

Surgery

Definite indications

Ñ    Renal stones

Ñ    Impaired renal function

Ñ    Bone involvement

Ñ    Hypercalcaemia > 3.0 mmol/L

Ñ    Age < 50 years

Ñ    Previous severe hypercalcaemia

Conservative approach

Ñ    Elderly

Ñ    Co-morbidity

 

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