Primary Hyperparathyroidism Overview
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Questions and Answers

What should be done before diagnosing normocalcemic primary hyperparathyroidism?

  • Check for familial hypercalcemic hypocalciuria, which can mimic the condition
  • Rule out the possibility of a jaw tumor, which is a common manifestation of hyperparathyroidism
  • Perform a thorough search for causes of secondary hyperparathyroidism, especially vitamin D deficiency (correct)
  • Assess the patient's calcium and PTH levels to confirm they are both elevated

    • Which of the following statements about normocalcemic primary hyperparathyroidism is true, according to the text?

  • It is considered a nascent form of hyperparathyroidism (correct)
  • It is a type of secondary hyperparathyroidism caused by vitamin D deficiency
  • It is a condition where both calcium and PTH levels are elevated
  • It is a genetic disorder associated with autosomal dominant mild hyperparathyroidism

    • What should be considered for patients suspected of having normocalcemic primary hyperparathyroidism?

  • Immediate surgical intervention to prevent further complications
  • Regular monitoring for progression of the disease, with surgery considered for development of symptoms (correct)
  • Treatment with thiazide diuretics to manage the condition
  • Genetic testing to determine if it is a familial form of the disorder

    • Which of the following statements about primary hyperparathyroidism is true, based on the information provided?

    <p>Its incidence is approximately 1/1000, with a predilection for postmenopausal women</p> Signup and view all the answers

    According to the information provided, what should be ruled out in patients suspected of having normocalcemic primary hyperparathyroidism?

    <p>Renal leak hypercalciuria</p> Signup and view all the answers

    Based on the information provided, which of the following statements is true regarding the diagnosis of primary hyperparathyroidism?

    <p>It is a biochemical diagnosis based on calcium and PTH levels</p> Signup and view all the answers

    What is the most common manifestation of Hyperparathyroidism-Jaw Tumor Syndrome (HPT-JT)?

    <p>Ossifying mandibular fibromas</p> Signup and view all the answers

    In Familial Hypercalcemic Hypocalciuria (FHH), what is the ratio of 24-hour urine calcium to creatinine clearance expected to be?

    <p>Less than 0.01</p> Signup and view all the answers

    What is the main genetic association with Neonatal Severe Hyperparathyroidism (NSHPT)?

    <p>CASR gene</p> Signup and view all the answers

    Which autosomal dominant syndrome presents with hypercalcemia and hypercalcuria?

    <p>Autosomal Dominant Mild Hyperparathyroidism</p> Signup and view all the answers

    What is the distinguishing feature between Familial Isolated Hyperparathyroidism (FIHPT) and other syndromes mentioned?

    <p>Presentation of kidney stones</p> Signup and view all the answers

    Which syndrome should be considered when patients present with asymptomatic nonprogressive lifelong hypercalcemia?

    <p>Familial Hypercalcemic Hypocalciuria</p> Signup and view all the answers

    What should patients with symptoms of emotional complaints, muscular fatigue, and constipation be screened for?

    <p><strong>Hyperparathyroidism</strong></p> Signup and view all the answers

    What is the threshold for calcium level above the upper limit of normal, as per the NIH Consensus Guidelines for Asymptomatic Hyperparathyroidism?

    <p>0.25 mmol/L</p> Signup and view all the answers

    In the context of hyperparathyroidism, what does a DEXA revealing a T score greater than −2.5 indicate?

    <p>Osteoporosis</p> Signup and view all the answers

    What is the recommended creatinine clearance level for considering surgical management of Asymptomatic Hyperparathyroidism?

    <p>Less than 60 mL/min</p> Signup and view all the answers

    For patients with Asymptomatic Hyperparathyroidism, what is the significance of having kidney stones or nephrocalcinosis on imaging?

    <p>Increased stone risk on stone analysis</p> Signup and view all the answers

    In the preoperative evaluation of hyperparathyroidism, what is normocalcemic HPT characterized by?

    <p>Elevated PTH level with high normal calcium level</p> Signup and view all the answers

    How do the NIH Consensus Guidelines generally favor surgical management in patients with Asymptomatic Hyperparathyroidism?

    <p>Young, healthy patients or older patients with disease sequelae</p> Signup and view all the answers

    What is the primary advantage of using MRI for detecting parathyroid lesions?

    <p>MRI does not require the use of iodinated contrast agents.</p> Signup and view all the answers

    What is the recommended imaging technique if sestamibi and ultrasound exams are negative or discordant?

    <p>Utilize 4D-CT scanning, as it can detect missed parathyroid glands.</p> Signup and view all the answers

    What is the primary purpose of performing a fine-needle aspiration (FNA) in cases of suspected parathyroid lesions?

    <p>To differentiate between parathyroid and thyroid lesions.</p> Signup and view all the answers

    What is the purpose of performing selective venous sampling in the evaluation of parathyroid lesions?

    <p>To localize the source of excess parathyroid hormone production.</p> Signup and view all the answers

    What is the purpose of intraoperative parathyroid hormone (PTH) measurement during parathyroid surgery?

    <p>To confirm the removal of the affected parathyroid gland(s).</p> Signup and view all the answers

    What is the recommended method for identifying and removing parathyroid glands intraoperatively, according to Norman and colleagues?

    <p>Radiation-guided parathyroid gland identification and removal using sestamibi.</p> Signup and view all the answers

    What is the most accurate and commonly used study for preoperative localization of parathyroid adenomas?

    <p>Technetium-99m sestamibi</p> Signup and view all the answers

    Which imaging technique can help identify parathyroid glands located in unusual anatomical positions?

    <p>MRI</p> Signup and view all the answers

    What technique is particularly helpful for ruling out intrathyroidal parathyroid adenomas?

    <p>Ultrasound</p> Signup and view all the answers

    What has been found to be more accurate and have a better positive predictive value than sestamibi scans or radiology-performed ultrasounds for preoperative localization?

    <p>Neck ultrasound</p> Signup and view all the answers

    What causes false positives in localization studies because of uptake in thyroid nodules or lymph nodes?

    <p>Technetium-99m sestamibi</p> Signup and view all the answers

    Which imaging technique is not helpful for finding mediastinal adenomas?

    <p>Ultrasound</p> Signup and view all the answers

    What is a limitation of sestamibi when it comes to multigland hyperplasia?

    <p>Inadequate localization</p> Signup and view all the answers

    MRI and CT are less commonly used as routine preoperative imaging for parathyroid adenomas because:

    <p>They have lower specificity compared to sestamibi</p> Signup and view all the answers

    Which technique increases the sensitivity of technetium-99m sestamibi for detecting smaller adenomas?

    <p>Single-photon emission computed tomography (SPECT)</p> Signup and view all the answers

    For reoperative parathyroidectomy, many surgeons favor how many confirming localization procedures before revision surgery?

    <p>Two</p> Signup and view all the answers

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