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Pathology
Excess production of parathyroid hormone from the parathyroid gland causing hypercalcaemia, calciuria, renal stones, nephrocalcinosis, hypertension, osteoporosis..
Aetiology
Primary: Parathyroid adenoma (85%), multiple gland hyperplasia (10-15%),
parathyroid carcinoma (1-5%). Can be part of Multiple endocrine
neoplasia (MEN) syndromes
Secondary: Chronic renal disease and Vitamin D deficiency
Tertiary: Autonomous hyperplasia due to prolonged secondary
hyperparathyroidism
Signs
Related to high calcium. Could be an incidental finding. Also features of chronic kidney disease
Symptoms
50% asymptomatic or related to high calcium
Investigations
Bloods: Parathyroid Hormone, Calcium Profile, U&E, if MEN suspected then
pituitary profile and serum calcitonin assay (medullary thyroid cancer)
Imaging: Chest X-ray, Abdominal X-ray, Isotope bone scan, CT/MRI, parathyroid
subtraction scan
Treatment
Medical: Bone protection, hydration, bisphosphonates
Surgical: Parathyroidectomy particularly if adenoma or carcinoma
Prognosis
Usually good unless underlying malignancy or CKD
Related to high calcium. Complications from surgery include haemorrhage, incomplete excision, and recurrent laryngeal nerve injury
Key Facts
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Key References
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