Questions and Answers
What is the primary characteristic of Hyperparathyroid disease?
What is the most common cause of Primary Hyperparathyroid disease?
What is a complication of elevated PTH levels?
What is the effect of excessive PTH concentrations on bone?
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Which age group is Primary Hyperparathyroid disease more frequent in?
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What is the incidence of new cases of Hyperparathyroid disease annually?
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Which of the following is NOT a mechanism by which PTH increases serum calcium concentrations?
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What is a potential underlying cause of Secondary Hyperparathyroid disease?
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What is the effect of PTH on the kidney?
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What is a laboratory finding that may indicate Secondary Hyperparathyroid disease secondary to Lung Cancer?
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What is the consequence of excessive circulating PTH and calcium on urine pH?
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What is the role of vitamin D in PTH-mediated calcium absorption?
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What is the prevalence of Hyperparathyroid disease in children?
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What is the consequence of excessive PTH and calcium on renal stone formation?
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What is the effect of PTH on osteoclast activity?
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What is the net effect of PTH on serum calcium concentrations?
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What is the effect of hypercalcemia on the gastrointestinal tract in HPTH disease?
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Which of the following is a characteristic of primary HPTH disease?
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What is the relationship between the size of a parathyroid adenoma and the serum PTH concentration?
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Which of the following is NOT a characteristic of secondary HPTH disease?
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What is the purpose of imaging tests in HPTH disease?
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What is the clinical hallmark of primary HPTH disease?
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Which of the following tests is used to diagnose HPTH disease?
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What is scintigraphy used for in diagnosing diseases?
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What is the recommended treatment for asymptomatic HPTH disease with high serum calcium levels?
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What is the goal of subtotal parathyroidectomy in treating parathyroid hyperplasia?
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Why are patients with HPTH disease advised to avoid thiazide diuretics?
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What is the treatment for parathyroid carcinomas?
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Why is calcium carbonate given orally after surgery?
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What is the cause of paresthesias and tetany after surgery?
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What is the treatment for symptomatic hypocalcemia?
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What is the main purpose of administering propranolol in patients with hyperparathyroid disease?
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What is the treatment of choice for severe hypercalcemia associated with hyperparathyroid disease?
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What is the mechanism of action of bisphosphonates in treating hypercalcemia?
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Why is vitamin D replacement beneficial in patients with hyperparathyroid disease?
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What is the effect of cinacalcet hydrochloride on parathyroid hormone secretion?
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What is a potential complication of hypercalcemia associated with hyperparathyroid disease?
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What is the goal of treatment for bone disease associated with secondary hyperparathyroidism in renal failure patients?
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What is the route of administration of bisphosphonates in treating hypercalcemia associated with hyperparathyroid disease?
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Study Notes
Hyperparathyroid Disease (HPTH)
- Characterized by excessive secretion of parathyroid hormone (PTH) from one or more parathyroid glands, leading to hypercalcemia, hypophosphatemia, and increased excretion of calcium and phosphate by the kidneys.
Etiologies
- Primary HPTH: caused by a tumor in one of the parathyroid glands, leading to excessive PTH secretion.
- Secondary HPTH: caused by chronic disease states, such as chronic renal failure, leading to decreased serum calcium levels and parathyroid cell hyperplasia.
Prevalence
- Primary HPTH: incidence of 0.1-0.2%, more frequent in persons older than 40 years, and 2-3 times more common in women than men.
- Secondary HPTH: rare in children, with an overall incidence of new cases approximately 0.03% annually.
Pathophysiology
- PTH stimulates osteoclasts, leading to excessive bone resorption and demineralization.
- PTH increases calcium reabsorption in the kidneys.
- PTH stimulates vitamin D synthesis, leading to increased gastrointestinal calcium absorption.
Clinical Manifestations
- Hypercalcemia: can lead to abdominal pain, peptic ulcer disease, constipation, and neuro psychiatric illnesses.
- Muscular weakness and muscle pain (myalgia) are linked to degenerative changes in muscles and nerves.
- Hypercalcemia can cause susceptibility to developing calcium-containing kidney stones.
Diagnosis
- Characterized by a significant elevation in serum PTH concentration.
- Immunoradiometric assay (IRMA) is a specific and sensitive test for PTH.
- Hypercalcemia is often present, with urinary calcium and phosphate levels elevated, and serum phosphate typically low.
- Bone x-ray changes may be present, but are not required for a definitive diagnosis.
Treatment
- Surgical removal of parathyroid glands (parathyroidectomy) is recommended for symptomatic HPTH disease.
- Non-pharmacologic and pharmacologic treatments may also be applicable.
- Patients with mild, asymptomatic disease should keep active, avoid immobilization, and drink plenty of fluids.
Complications and Prognosis
- Serious complications include renal failure, pathologic fractures, and hypercalcemia-induced pancreatitis.
- Prognosis is generally good with treatment, but severe complications can increase mortality rates.
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Description
Test your knowledge of hyperparathyroid disease, an endocrine disorder characterized by excessive secretion of parathyroid hormone, leading to hypercalcemia and other symptoms.