Hyperparathyroidism

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Hyperparathyroidism

  1. 1.  Renal tubules Increases reabsorption of calcium Increases phosphate excretion by restricting its reabsorption Bone Promotes osteoclastic resorption and release of calcium and phosphate into blood
  2. 2.  Intestine Stimulates calcium absorption by promoting the conversion of vitamin D to its active metabolite in the kidney
  3. 3.  Primary – Adenoma, Hyperplasia or carcinoma Secondary – In renal diseae Tertiary – When secondary hyperplasia leads to autonomous overactivity
  4. 4.  Pathology Hypercalcemia Hypercalciuria Hyperphosphoturia Kidney:Calcinosis,stone formation,recurrent infection and impaired function
  5. 5.  General loss of bone substance Subperiosteal erosion Endosteal cavitation Osteitis fibrosa cystica :Replacement of marrow spaces by vascular granulations and fibrous tissue Brown tumor:Haemorrhage and giant cell reaction within fibrous stroma gives rise to brownish tumor like masses, whose liquefaction leads to fluid filled cysts
  6. 6.  Middle aged(40-65 years) Women are affected twice as often as men Many remain asymptomatic Stones,Bones,Groans Anorexia,nausea,abdominal pain,depression,fatigue and muscle weakness Polyuria,kidney stones Joint symptoms due to chondrocalcinosis
  7. 7. • Osteoporosis• Subperiosteal cortical resorption of middle phalanges• Vertebral collapse• Brown tumors• Renal calculi,Nephrocalcinosis• Chondrocalcinosis
  8. 8.  Hypercalcemia Hypophosphataemia Raised PTH Raised serum alkaline phosphatase
  9. 9.  Phosphate excretion test Phosphorous loading Dietary Phosphorous and Calcium deprivation Urinary hydroxyproline Cortisone suppression Radioisotpe subtraction scanning
  10. 10.  Exclusion of other causes of hypercalcemia like multiple myeloma,metastatic disease,sarcoidosis in which PTH levels are usually are depressed All types of osteoporosis and osteomalacia
  11. 11.  Adequate hydration Phosphate ingestion Decreased calcium intake Parathyroidectomy: Indications ◦ Marked and unremitting hypercalcemia ◦ Recurrent renal calculi ◦ Progressive nephrocalcinosis ◦ Severe osteoporosis
  12. 12. Postoperative severe hypocalcemia due to brisk formation of new boneMust be treated promptly with fast acting vit D metabolites
  13. 13.  Seen in Renal rickets and Reanl osteomalacia Treatment is directed at primary condition
  14. 14.  < 10 % Fracture neck of femur is common Fracture line is usually vertical at the base of the neck with preexistent coxa vara Young patients-Valgus osteotomy Elderly patients-Primary arthroplasty
  15. 15.  Accidental removal of parathyroids during thyroidectomy Low serum Calcium and high serum phosphorous Signs of neuromuscular excitation PTH/Dihydrotachysterol Diet high in calcium Milk is contraindicated due to its high phosphrous Infusions of Magnesium sulfate restore the serum calcium levels to normal
  16. 16.  Congenital lack of adenyl cyclase Production of PTH is adequate Target organs do not respond to the hormone Urinary excretion of cyclic AMP reduced Dehydrotachysterol/Vit D2

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