The document discusses primary hyperparathyroidism, which is caused by adenomas, hyperplasia, or carcinoma of the parathyroid glands. It causes increased calcium absorption and bone resorption while promoting calcium and phosphate excretion in the kidneys. Symptoms include kidney stones, bone loss, fatigue, and abdominal pain. Diagnosis involves blood tests showing elevated calcium and PTH levels. Treatment is parathyroidectomy for severe cases.

2.  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

3.  Intestine
Stimulates calcium absorption by promoting the
conversion of vitamin D to its active metabolite in the
kidney

4.  Primary – Adenoma, Hyperplasia or carcinoma
 Secondary – In renal diseae
 Tertiary – When secondary hyperplasia leads to
autonomous overactivity

5.  Pathology
 Hypercalcemia
 Hypercalciuria
 Hyperphosphoturia
 Kidney:Calcinosis,stone formation,recurrent
infection and impaired function

6.  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

7.  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

8. • Osteoporosis
• Subperiosteal cortical resorption of middle phalanges
• Vertebral collapse
• Brown tumors
• Renal calculi,Nephrocalcinosis
• Chondrocalcinosis

17.  Hypercalcemia
 Hypophosphataemia
 Raised PTH
 Raised serum alkaline phosphatase

18.  Phosphate excretion test
 Phosphorous loading
 Dietary Phosphorous and Calcium deprivation
 Urinary hydroxyproline
 Cortisone suppression
 Radioisotpe subtraction scanning

19.  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

20.  Adequate hydration
 Phosphate ingestion
 Decreased calcium intake
 Parathyroidectomy: Indications
◦ Marked and unremitting hypercalcemia
◦ Recurrent renal calculi
◦ Progressive nephrocalcinosis
◦ Severe osteoporosis

21. Postoperative severe hypocalcemia due to brisk formation
of new bone
Must be treated promptly with fast acting vit D
metabolites

22.  Seen in Renal rickets and Reanl osteomalacia
 Treatment is directed at primary condition

23.  < 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

24.  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

25.  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