summary Hyperparathyroidism is the increase in serum parathyroid hormone (PTH) production that may be of primary, secondary or tertiary causes. Diagnosis is made based on evaluation of serum labs and clinical evaluation. Treatment can be medical management or tumor resection depending on underlying cause of disease. Epidemiology Incidence occurs in 0.1% of the population 90% result form a single adenoma remaining 10% from parathyroid hyperplasia Demographics more common in women hyperparathyroidism and malignancy make up the majority of patients with hypercalcemia Etiology Pathophysiology PTH indirectly stimulates osteoclasts by binding to its receptor on osteoblasts, inducing RANK-L and M-CSF synthesis Excessive PTH leads to over-stimulation of bone resorption cortical bone affected more than cancellous Associated conditions Brown tumor resembles a giant cell tumor of bone relating to focal demineralization of bone in the setting of hyperparathyroidism. Classification Primary typically the result of hypersecretion of PTH by a parathyroid adenoma/hyperplasia may result in osteitis fibrosa cystica breakdown of bone, predominently subperiosteal bone commonly involves the jaw Secondary secondary parathyroid hyperplasia as compensation from hypocalcemia or hyperphosphatemia ↓ gut Ca2+ absorption ↑ phosphorous associated conditions chronic renal disease renal disease causes hypovitaminosis D leads to ↓ Ca2+ absorption renal osteodystrophy bone leisons due to secondary hyperparathyroidism Tertiary parathyroid glands become dysregulated after secondary hyperparathyroidism secrete PTH regardless of Ca2+ level Primary, Secondary and Tertiary hyperparathyroidism Serum Ca Serum Phos Serum PTH Primary Increased Decreased Increased Secondary Normal or decreased Increased Increased Tertiary Increased Increased Increased Presentation Symptoms often asymptomatic weakness kidney stones ("stones") bone pain ("bones") constipations ("groans") uncommon cause of secondary hypertension Evaluation Serology primary hypercalcemia ↑ PTH secondary hypocalcemia/normocalcemia ↑ PTH malignancy ↓ PTH ↑ alkaline phosphatase normal anion gap metabolic acidosis ↓ renal reclamation of bicarbonate Urinalysis primary hypercalciuria (renal stones) ↑ cAMP Radiograph cystic bone spaces ("salt and pepper") often in the skull loss of phalange bone mass ↑ concavity (see key image of this topic) EKG shortened QT Treatment Acute hypercalcemia IV fluids Loop diuretics Symptomatic hypercalcemia is treated surgically treat with parathyroidectoy complications include post-op hypocalcemia manifests as numbness, tingling, and muscle cramps should be treated with IV calcium gluconate Complications Peptic ulcer disease ↑ gastrin production stimulated by ↑ Ca2+ Acute pancreatitis ↑ lipase activity stimulated by ↑ Ca2+ CNS dysfunction anxiety, confusion, coma result of metastatic calcification of the brain Osteoporosis bone loss occurs as result of bone resorption due to excess PTH orthopedic surgeons should recognize lab abnormalities as patients may present with fragility fractures
QUESTIONS 1 of 5 1 2 3 4 5 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ13.185) A 25-year-old female presents to the emergency room within increasing left shoulder pain after walking into a door 5 months ago. She previously sustained a femoral fracture 2 years ago after tripping on a rug. Relevant skeletal survey radiographs and tissue biopsy results are shown in Figures A through D. Laboratory investigations show normal glomerular filtration rate and creatinine clearance. Dual energy x-ray absorptiometry (DEXA) scan shows T-score of -1.4 and -1.2 at the hip and lumbar spine, respectively. Which of the following laboratory values in Figure E most likely reflects this patient's condition? QID: 4820 FIGURES: A B C D E Type & Select Correct Answer 1 A 46% (2095/4512) 2 B 24% (1098/4512) 3 C 14% (617/4512) 4 D 9% (385/4512) 5 E 6% (256/4512) L 4 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 1 Review Tested Concept Review Full Topic Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ11.57) A 35-year-old female complains of 1 month of right hip pain during ambulation. Her medical history includes end-stage renal disease for which she is on hemodialysis three times per week. A radiograph of the right hip, spine, and skull are shown in Figures A-C. Figure D shows a histology microphotograph of a biopsy specimen. All of the following laboratory findings are associated with this condition EXCEPT? QID: 3480 FIGURES: A B C D Type & Select Correct Answer 1 Hypophosphatemia 50% (1495/3007) 2 Hypocalcemia 19% (578/3007) 3 Decreased 1,25-(OH)2-vitamin D3 9% (264/3007) 4 Increased alkaline phosphatase 14% (409/3007) 5 Increased BUN 8% (244/3007) L 4 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 1 Review Tested Concept Review Full Topic Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK
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Femoral Antegrade Intramedullary Femoral Nailing Secondary Hyperparathyroidism with Pathological Fracture Rt.Distal Femur with Brown Tumours (C1518) Sandip Adhikari Basic Science - Hyperparathyroidism E 5/22/2013 229 0 4