Hyperparathyroidism

Three TYPES of hyperparathyroidism wit CAUSES-
1. Primary -autonomous                        secretion of PTH                by parathyroid.                 Serum Ca & PTH raised.         causes - single                                adenoma
        multiple adenomata, nodular hyperplasia

2. Secondary -
      parathyroid hyperplasia wit increased PTH secretion. Serum Ca low & PTH raised.
 causes - chronic renal failure, malabsorption, osteomalacia & rickets.

3. Tertiary -
 serum Ca & PTH raised.

Clinical Features -
1. Non specific symptoms-
- anorexia, nausea,vomiting, cönstipation & wt. loss.
- weakness, lassitude & tiredness.
- drowsiness, poor concentration, depression.
2. Renal manifestation -
- polyuria & polydipsia
- recurrent calculus formation.
-nephrocalcinosis
- impairment of renal function wit uraemia, hypokalaemia, hyperuricemia
3. Skeletal manifestations -
- bone pain, fractures & deformity due to osteitis fibrosa
-localised bone swelling
- degenerative arthritis & attacks of acute pseudogout
- other manifestations -
  corneal  calcification
  peptic ulcer
hypertension
myopathy
4. Multiple endocrine neoplasia (MEN)
  Type 1 = pituitary, pancreas, parathyroid tumor + Zollinger _Ellison syndrome
  Type2A = phaeochromocytoma & medullary carcinoma of thyroid + hyperparathyroidism
   Type2B = additional multiple neuroma.
 INVESTIGATION_
1. Biochemical abnormality _
_ raised serum calcium & raised PTH.
- serum phosphate low
- serum chloride raised.
- serum alkaline phosphatase raised.
2. ECG
- Shortened QT interval
- cardiac arrythmias
3. Radiological examin
- demineralisation & subperiosteal erosions of phalanges
- resorption of terminal phalanges.
-Pepper-pot' appearance of skull on lateral side
-nephrocalcinosis
- soft tissue calcification
4. Dual-energy x-ray absorptiometry & CT scan show reduced bone density.
5. Investigation for localising tumor
-USG
-Selective neck vein catheterisation wit PTH measure
-CT scanning & subtraction imaging

TREATMENT-
- Tseat of hypercalcemia
-adenoma treated by surgical removal
- hyperplasia treated by removal of all four glands & transplantation of some of excised tissue of forearm.