Patient will present as → a 62-year-old female complaining of joint pain, polyuria, polydipsia, and generalized fatigue. The patient reports a history of recurrent kidney stones and depression. Radiographs show osteopenia and subperiosteal resorption on the phalanges (Bones, stones, abdominal groans and psychic moans)
Hyperparathyroidism is a condition in which one or more of the parathyroid glands become overactive and secrete too much parathyroid hormone (PTH). This causes the levels of calcium in the blood to rise
- Most patients with calcium levels < 12 are asymptomatic
- Symptoms usually begin as the calcium level rises above 12, and the symptoms will worsen as the calcium level continues to rise
- Initially, patients may complain of nausea and vomiting with a loss of appetite. They may feel muscle weakness and fatigue and constipation may be present
- As the calcium level rises, they may become confused and lethargic. Polyuria can occur with renal failure. Cardiac arrhythmias can occur and even coma.
Hyperparathyroidism always = ↑ PTH
Hyperparathyroidism has two cause: primary and secondary
- Primary = ↑ PTH usually caused by a PTH secreting parathyroid ADENOMA
- Secondary =↑ PTH by a physiologic response to hypocalcemia or vitamin D deficiency. Chronic kidney disease is the most common cause of secondary hyperparathyroidism.
Osteoporosis, renal calculi, bone pain, GI symptoms, depression, psychosis, fatigue
Bones, Stones, Groans and Psychic Moans
- Bone loss from ↑ PTH and calcium absorption from bones = pain in bones
- Renal loss of calcium and phosphate = kidney stones
- Increase GI absorption of calcium and abdominal cramps = groans
- Irritability, psychosis, and depression = moans
|Serum Ca||Serum Phos||Serum PTH|
|Secondary||normal or ↓||↑||↑|
↑ Calcium is the most common metabolic abnormality associated with hyperparathyroidism
↑ PTH secretion from the parathyroid raises the blood calcium level by:
- Breaking down the bone (where most of the body's calcium is stored) and causing calcium release
- Increasing the body's ability to absorb calcium from food from the GI tract
- Increasing the kidney's ability to hold on to calcium that would otherwise be lost in the urine
This results in increased serum and urinary calcium, osteoporosis, and renal calculi.
- ↑ Calcium is the most common metabolic abnormality
- Blood: ↑ PTH, ↑ Calcium, ↓ phosphorus
- Urine: hyperphosphaturia, hypercalciuria this makes sense because all that calcium and phosphorus have to go somewhere, so they go out through the kidneys and into the urine.
Remove the PARATHYROID adenoma, subtotal parathyroidectomy (3 1/2 of gland removed) or total parathyroidectomy.
- If it is secondary then once you replace the cause (Vitamin D and Calcium supplementation) you will have fixed the problem.
- If the calcium is very high you will need to treat with IV fluids, Furosemide or Calcitonin.
- May need to treat osteoporosis with Bisphosphonates.
serum calcium 11.5 mg/dL (normal 8.5 to 10.5 mg/dL)
ionized calcium 3.2 mg/dL (normal 4.6 to 5.3 mg/dL)
Ionized calcium levels are invariably increased in primary hyperparathyroidism, typically greater than 5.4 mg/dL.
serum magnesium 1.1 mEq/L (normal 1.3 to 2.1 mEq/L)
Serum magnesium is not affected in primary hyperparathyroidism.
serum phosphate 3.0 mg/dL (normal 2.5 to 4.5 mg/dL)
Serum phosphate is usually low in primary hyperparathyroidism.