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Hiperparatiroidismo

Hiperparatiroidismo

El hiperparatiroidismo es una condición asociada a niveles elevados de la hormona paratiroidea (PTH, por sus siglas en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum inglés) en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la sangre. Dependiendo de la patogénesis de esta condición, el hiperparatiroidismo puede definirse como primario, secundario o terciario. El hiperparatiroidismo primario es una enfermedad inherente a las glándulas paratiroides asociada a una secreción anormal de PTH. El hiperparatiroidismo secundario es el resultado de anomalías en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el metabolismo del calcio que, si no se trata, pueden evolucionar a un hiperparatiroidismo terciario, que se asocia a una hipertrofia de la glándula paratiroidea y a una hipersecreción de PTH incluso si se elimina la causa primaria. El diagnóstico se basa en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria parámetros bioquímicos, que incluyen los LOS Neisseria niveles séricos de PTH, calcio y fosfato, así como el calcio urinario. El tratamiento se basa principalmente en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la paratiroidectomía quirúrgica para el hiperparatiroidismo primario y terciario. El manejo del hiperparatiroidismo secundario se centra en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el tratamiento de la enfermedad subyacente.

Last updated: Dec 15, 2025

Editorial responsibility: Stanley Oiseth, Lindsay Jones, Evelin Maza

Contents

Descripción General

Definición

El hiperparatiroidismo es una enfermedad asociada a niveles elevados de la hormona paratiroidea (PTH) en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la sangre.

Etiología

  • Hiperparatiroidismo primario:
    • La causa más común de hipercalcemia
    • Puede asociarse a Neoplasia Endocrina Múltiple 1
    • Adenomas de la glándula paratiroidea (85% de los LOS Neisseria casos, principalmente solitarios)
    • Enfermedad paratiroidea multiglandular primaria relacionada con el hiperpartiroidismo (~ 10%; antes denominada “hiperplasia” paratiroidea)
    • Carcinoma paratiroideo (1%)
  • Hiperparatiroidismo secundario:
    • Elevación secundaria de la PTH causada por la hipocalcemia
    • Es la causa más común de PTH secundaria:
      • Enfermedad renal crónica (ERC)
      • Deficiencia de vitamina D
      • ↓ Absorción de Ca CA Condylomata acuminata are a clinical manifestation of genital HPV infection. Condylomata acuminata are described as raised, pearly, flesh-colored, papular, cauliflower-like lesions seen in the anogenital region that may cause itching, pain, or bleeding. Condylomata Acuminata (Genital Warts) enteral
      • Cirrosis hepática
  • Hiperparatiroidismo terciario:
    • Debido a un hiperparatiroidismo secundario de larga duración
    • Suele estar asociado a enfermedad renal terminal
    • Hipertrofia de la glándula paratiroidea y sobre secreción de PTH debido a una estimulación crónica de larga data
Parathyroid adenoma

Adenoma paratiroideo que afecta a la glándula paratiroidea superior derecha
Las otras tres glándulas se muestran de forma prominente, pero las paratiroides normales son más pequeñas de lo que parecen (tamaño normal, 3-5 mm; 30-60 mg cada una).

Imagen: “Blausen 0533 Parathyroid adenoma” por BruceBlaus. Licencia: CC BY 3.0

Epidemiología

  • Hiperparatiroidismo primario:
    • 66 por 100 000 personas al AL Amyloidosis año en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum mujeres
    • 25 por 100 000 personas al AL Amyloidosis año en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum hombres
    • Edad media al AL Amyloidosis momento del diagnóstico: 52-56 años
  • Hiperparatiroidismo secundario:
    • La carencia de vitamina D afecta hasta al AL Amyloidosis 40% de los LOS Neisseria adultos en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum Estados Unidos.
    • El hiperparatiroidismo secundario está presente hasta en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el 90% de los LOS Neisseria pacientes con ERC grave que posiblemente necesiten diálisis.
  • Hiperparatiroidismo terciario:
    • Se desarrolla en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum algunos pacientes con ERC con hiperparatiroidismo secundario de larga data
    • Persiste después del trasplante de riñón

Fisiopatología

Efectos fisiológicos normales de la PTH

  • Secretado por las glándulas paratiroides en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum respuesta a la disminución de los LOS Neisseria niveles de calcio ( Ca CA Condylomata acuminata are a clinical manifestation of genital HPV infection. Condylomata acuminata are described as raised, pearly, flesh-colored, papular, cauliflower-like lesions seen in the anogenital region that may cause itching, pain, or bleeding. Condylomata Acuminata (Genital Warts)) sérico detectados por el receptor Receptor Receptors are proteins located either on the surface of or within a cell that can bind to signaling molecules known as ligands (e.g., hormones) and cause some type of response within the cell. Receptors sensor de Ca CA Condylomata acuminata are a clinical manifestation of genital HPV infection. Condylomata acuminata are described as raised, pearly, flesh-colored, papular, cauliflower-like lesions seen in the anogenital region that may cause itching, pain, or bleeding. Condylomata Acuminata (Genital Warts)
  • Estimula la actividad de los LOS Neisseria osteoclastos → ↑ resorción ósea con liberación de Ca CA Condylomata acuminata are a clinical manifestation of genital HPV infection. Condylomata acuminata are described as raised, pearly, flesh-colored, papular, cauliflower-like lesions seen in the anogenital region that may cause itching, pain, or bleeding. Condylomata Acuminata (Genital Warts) y fosfato en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la sangre
  • ↑ Reabsorción de Ca CA Condylomata acuminata are a clinical manifestation of genital HPV infection. Condylomata acuminata are described as raised, pearly, flesh-colored, papular, cauliflower-like lesions seen in the anogenital region that may cause itching, pain, or bleeding. Condylomata Acuminata (Genital Warts) en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el riñón
  • ↑ Eliminación del fosfato en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el riñón
  • ↑ 1-hidroxilación de la vitamina D en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el riñón
  • ↑ Absorción intestinal del Ca CA Condylomata acuminata are a clinical manifestation of genital HPV infection. Condylomata acuminata are described as raised, pearly, flesh-colored, papular, cauliflower-like lesions seen in the anogenital region that may cause itching, pain, or bleeding. Condylomata Acuminata (Genital Warts) de la dieta vía ↑ producción de vitamina D activa

Fisiopatología

Hiperparatiroidismo primario:

  • En EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria adenomas paratiroideos, la expresión del receptor Receptor Receptors are proteins located either on the surface of or within a cell that can bind to signaling molecules known as ligands (e.g., hormones) and cause some type of response within the cell. Receptors sensor de Ca CA Condylomata acuminata are a clinical manifestation of genital HPV infection. Condylomata acuminata are described as raised, pearly, flesh-colored, papular, cauliflower-like lesions seen in the anogenital region that may cause itching, pain, or bleeding. Condylomata Acuminata (Genital Warts) está reducida, lo que conduce a una secreción no regulada de PTH.
  • En la enfermedad multiglandular paratiroidea, múltiples proliferaciones neoplásicas benignas “clonales” secretan PTH
  • ↑ PTH → efectos en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria riñones y los LOS Neisseria huesos.
  • ↑ Ca CA Condylomata acuminata are a clinical manifestation of genital HPV infection. Condylomata acuminata are described as raised, pearly, flesh-colored, papular, cauliflower-like lesions seen in the anogenital region that may cause itching, pain, or bleeding. Condylomata Acuminata (Genital Warts) y ↓ niveles de fosfato sérico.

Hiperparatiroidismo secundario:

  • ↓ Ca CA Condylomata acuminata are a clinical manifestation of genital HPV infection. Condylomata acuminata are described as raised, pearly, flesh-colored, papular, cauliflower-like lesions seen in the anogenital region that may cause itching, pain, or bleeding. Condylomata Acuminata (Genital Warts)2+ y ↑ fosfato estimulan la secreción de PTH
  • La hipocalcemia y la hiperfosfatemia pueden ser consecuencia de:
    • ERC:
      • ↓ Calcitriol Calcitriol The physiologically active form of vitamin d. It is formed primarily in the kidney by enzymatic hydroxylation of 25-hydroxycholecalciferol (calcifediol). Its production is stimulated by low blood calcium levels and parathyroid hormone. Calcitriol increases intestinal absorption of calcium and phosphorus, and in concert with parathyroid hormone increases bone resorption. Parathyroid Glands: Anatomy
      • ↓ Reabsorción de Ca CA Condylomata acuminata are a clinical manifestation of genital HPV infection. Condylomata acuminata are described as raised, pearly, flesh-colored, papular, cauliflower-like lesions seen in the anogenital region that may cause itching, pain, or bleeding. Condylomata Acuminata (Genital Warts)
      • ↓ Secreción de fosfato
    • Deficiencia de vitamina D (nutricional, enfermedad hepática)
    • Resistencia a la vitamina D (síndrome de Fanconi, defectos del receptor Receptor Receptors are proteins located either on the surface of or within a cell that can bind to signaling molecules known as ligands (e.g., hormones) and cause some type of response within the cell. Receptors de la vitamina D)
    • Resistencia a la PTH (pseudohipoparatiroidismo, hipomagnesemia)
    • Medicamentos:
      • Quelantes de Ca CA Condylomata acuminata are a clinical manifestation of genital HPV infection. Condylomata acuminata are described as raised, pearly, flesh-colored, papular, cauliflower-like lesions seen in the anogenital region that may cause itching, pain, or bleeding. Condylomata Acuminata (Genital Warts) (transfusiones de sangre con citrato, fosfato de la leche de vaca)
      • Inhibidores de la resorción ósea (bifosfonatos, calcitonina, plicamicina)
      • Alteración del metabolismo de la vitamina D (fenitoína, ketoconazol)
    • Misceláneas:
      • Pancreatitis Pancreatitis Inflammation of the pancreas. Pancreatitis is classified as acute unless there are computed tomographic or endoscopic retrograde cholangiopancreatographic findings of chronic pancreatitis. The two most common forms of acute pancreatitis are alcoholic pancreatitis and gallstone pancreatitis. Acute Pancreatitis aguda
      • Rabdomiólisis aguda
      • Lisis tumoral masiva
      • Metástasis osteoblásticas (carcinoma de próstata o cáncer de pulmón de células pequeñas)
      • Síndrome de shock Shock Shock is a life-threatening condition associated with impaired circulation that results in tissue hypoxia. The different types of shock are based on the underlying cause: distributive (↑ cardiac output (CO), ↓ systemic vascular resistance (SVR)), cardiogenic (↓ CO, ↑ SVR), hypovolemic (↓ CO, ↑ SVR), obstructive (↓ CO), and mixed. Types of Shock tóxico

Hiperparatiroidismo terciario:

  • Hiperestimulación crónica de la glándula paratiroides
  • Hipertrofia paratiroidea e hipersecreción autónoma de PTH
  • La hipercalcemia se desarrolla en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el marco de la hiperfosfatemia de la ERC.
  • Peligroso: puede dar lugar a una calcinosis Calcinosis Pathologic deposition of calcium salts in tissues. Scleroderma difusa
Diagrama esquemático del papel y la función de la hormona paratiroidea (PTH)

La hormona paratiroidea solo tiene una función: corregir la hipocalcemia y mantener el nivel sérico de calcio dentro de unos límites estrechos.
Si el calcio sérico es bajo, las cuatro glándulas paratiroides secretan PTH, que se fabrica y almacena en las glándulas. Cuando se libera, la PTH trabaja con y a través de la vitamina D para restablecer el nivel de calcio a la normalidad.

Imagen por Lecturio.

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Presentación Clínica

Hiperparatiroidismo primario ( PH pH The quantitative measurement of the acidity or basicity of a solution. Acid-Base Balance, por sus siglas en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum inglés)

Más del 50% de los LOS Neisseria pacientes son asintomáticos o presentan síntomas inespecíficos.

Mnemotecnia para el PH pH The quantitative measurement of the acidity or basicity of a solution. Acid-Base Balance: Piedras, huesos, quejas y lamentos:

  • Nefrolitiasis (cálculos de fosfato de calcio o de oxalato de calcio)
  • Puede progresar a nefrocalcinosis (depósito de Ca CA Condylomata acuminata are a clinical manifestation of genital HPV infection. Condylomata acuminata are described as raised, pearly, flesh-colored, papular, cauliflower-like lesions seen in the anogenital region that may cause itching, pain, or bleeding. Condylomata Acuminata (Genital Warts) en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria túbulos renales)
  • Tres anomalías esqueléticas observadas en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el Hiperparatiroidismo no tratado:
    • La osteoporosis Osteoporosis Osteoporosis refers to a decrease in bone mass and density leading to an increased number of fractures. There are 2 forms of osteoporosis: primary, which is commonly postmenopausal or senile; and secondary, which is a manifestation of immobilization, underlying medical disorders, or long-term use of certain medications. Osteoporosis:
      • Principalmente en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el hueso cortical (reabsorción subperióstica) de las falanges, las vértebras y el fémur proximal
      • El cráneo con signo de sal y pimienta se refiere a focos líticos difusos en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria huesos temporales
      • Aumento global del riesgo de fracturas
    • Tumores pardos: masas de tejido fibroso reactivo con macrófagos
      • Debido a la fuerte actividad de los LOS Neisseria osteoclastos
      • Producción de microfracturas
      • Se asocia con un aumento de la vascularidad, hemorragia y depósito de hemosiderina
    • Osteítis fibrosa quística (enfermedad ósea de von Recklinghausen): por hiperparatiroidismo severo, debido a la degeneración quística de muchos tumores pardos
  • Tracto gastrointestinal:
    • Estreñimiento
    • Distensión abdominal
    • Náuseas
    • Pérdida de apetito
    • Pérdida de peso
    • Úlceras gástricas y duodenales
    • Pancreatitis Pancreatitis Inflammation of the pancreas. Pancreatitis is classified as acute unless there are computed tomographic or endoscopic retrograde cholangiopancreatographic findings of chronic pancreatitis. The two most common forms of acute pancreatitis are alcoholic pancreatitis and gallstone pancreatitis. Acute Pancreatitis
  • Síntomas neuropsiquiátricos:
    • Depresión
    • Cambios de personalidad
    • Letargo
    • Coma Coma Coma is defined as a deep state of unarousable unresponsiveness, characterized by a score of 3 points on the GCS. A comatose state can be caused by a multitude of conditions, making the precise epidemiology and prognosis of coma difficult to determine. Coma

Otros síntomas son:

  • Debilidad muscular generalizada, fatiga muscular rápida
  • Cambios en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el electrocardiograma (bloqueo auriculoventricular, bradicardia, intervalo QT corto, hipertrofia ventricular izquierda)
  • Poliuria, polidipsia
  • Crisis de hiperparatiroidismo (poco frecuente):
    • Poliuria, polidipsia
    • Náusea/vómitos
    • Pérdida de conocimiento, somnolencia y coma Coma Coma is defined as a deep state of unarousable unresponsiveness, characterized by a score of 3 points on the GCS. A comatose state can be caused by a multitude of conditions, making the precise epidemiology and prognosis of coma difficult to determine. Coma

Hiperparatiroidismo secundario

  • No hay una presentación clínica única
  • Los LOS Neisseria pacientes con ERC pueden presentar dolor Dolor Inflammation óseo
  • Los LOS Neisseria casos asociados a la deficiencia de vitamina D presentan síntomas relacionados:
    • Osteomalacia Osteomalacia Disorder caused by an interruption of the mineralization of organic bone matrix leading to bone softening, bone pain, and weakness. It is the adult form of rickets resulting from disruption of vitamin d; phosphorus; or calcium homeostasis. Osteomalacia and Rickets, aumento de las fracturas
    • Miopatía
Radiografía de mano de hiperparatiroidismo secundario

Radiografía de la mano en una mujer de 64 años con hiperparatiroidismo secundario leve y una larga historia de tejido de punto, que muestra resorción ósea subperióstica en ambas falanges terminales del pulgar.
La reabsorción ósea debida al hiperparatiroidismo suele observarse en las puntas de las falanges y en las caras radiales de las falanges medias del segundo y el tercer dedo. La localización inusual en los pulgares en este paciente puede deberse a una combinación de traumatismo repetitivo e hiperparatiroidismo.

Imagen: “Unusual hand radiographic presentation in a patient on hemodialysis” por Pipili C, Grapsa E, Tzanatos H. Licencia: CC BY 2.0, edited by Lecturio.

Hiperparatiroidismo terciario

  • Dolor Dolor Inflammation de huesos
  • Prurito
  • Cansancio/letargo
  • Mayor riesgo de fracturas

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Diagnóstico

Hiperparatiroidismo primario

  • Pruebas de laboratorio:
    • ↑ Ca CA Condylomata acuminata are a clinical manifestation of genital HPV infection. Condylomata acuminata are described as raised, pearly, flesh-colored, papular, cauliflower-like lesions seen in the anogenital region that may cause itching, pain, or bleeding. Condylomata Acuminata (Genital Warts)2+ sérico:
      • Medir el Ca CA Condylomata acuminata are a clinical manifestation of genital HPV infection. Condylomata acuminata are described as raised, pearly, flesh-colored, papular, cauliflower-like lesions seen in the anogenital region that may cause itching, pain, or bleeding. Condylomata Acuminata (Genital Warts)2+ total del suero si la albúmina es normal
      • Medir el Ca CA Condylomata acuminata are a clinical manifestation of genital HPV infection. Condylomata acuminata are described as raised, pearly, flesh-colored, papular, cauliflower-like lesions seen in the anogenital region that may cause itching, pain, or bleeding. Condylomata Acuminata (Genital Warts)2+ ionizado si la albúmina es baja O
      • Calcular el calcio corregido: calcio corregido = Ca CA Condylomata acuminata are a clinical manifestation of genital HPV infection. Condylomata acuminata are described as raised, pearly, flesh-colored, papular, cauliflower-like lesions seen in the anogenital region that may cause itching, pain, or bleeding. Condylomata Acuminata (Genital Warts) 2+ sérico total + [0.8 x (4.0 – albúmina )]
    • ↑ Nivel de PTH
    • Ca CA Condylomata acuminata are a clinical manifestation of genital HPV infection. Condylomata acuminata are described as raised, pearly, flesh-colored, papular, cauliflower-like lesions seen in the anogenital region that may cause itching, pain, or bleeding. Condylomata Acuminata (Genital Warts)2+ urinario de 24 horas:
      • Elevado o normal
      • Ayuda a diferenciar la hipercalcemia hipocalciúrica familiar
    • ↓ O casi normal fosfato sérico
    • ↑ Fosfatasa alcalina
    • Variante normocalcémica:
      • Ca CA Condylomata acuminata are a clinical manifestation of genital HPV infection. Condylomata acuminata are described as raised, pearly, flesh-colored, papular, cauliflower-like lesions seen in the anogenital region that may cause itching, pain, or bleeding. Condylomata Acuminata (Genital Warts)2+ sérico total y ionizado normal en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum presencia de ↑ PTH
      • Suele tener una presentación temprana o leve del hiperparatiroidismo primario
      • El diagnóstico se realiza si se excluye el hiperparatiroidismo secundario.
  • Estudios de imagen:
    • No se utiliza de forma rutinaria para el diagnóstico
    • Puede utilizarse antes de la cirugía para la localización de tumores paratiroideos
    • Las radiografías pueden mostrar enfermedades óseas:
      • Resorción ósea subperióstica
      • Tumores pardos de los LOS Neisseria huesos largos
      • Acortamiento de las clavículas distales
      • Singo de sal y pimienta en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum cráneo
      • Quistes óseos
Radiografía de la osteítis fibrosa quística del miembro inferior izquierdo

Radiografía del miembro inferior izquierdo en dos vistas ortogonales que muestra una osteítis fibrosa quística que se presenta como un espacio óseo quístico/lítico lleno de tejido fibroso pardo (flechas) conocido como “tumor pardo”:
Hoy en día, los tumores pardos son menos frecuentes en el hiperparatiroidismo porque la enfermedad suele diagnosticarse en una fase más temprana.

Imagen: “Case 2: x-ray: extensive osteolytic lesion in proximal end of tibia (arrows)” por Waldemar Misiorowski et al. Licencia: CC BY 4.0

Hiperparatiroidismo secundario

  • ↓ Ca CA Condylomata acuminata are a clinical manifestation of genital HPV infection. Condylomata acuminata are described as raised, pearly, flesh-colored, papular, cauliflower-like lesions seen in the anogenital region that may cause itching, pain, or bleeding. Condylomata Acuminata (Genital Warts)2+ sérico
  • ↑ O niveles normales de fosfato
  • ↑ Nivel de PTH
  • El nivel de 25-hidroxivitamina D puede ser bajo en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la deficiencia de vitamina D.

Hiperparatiroidismo terciario

  • ↑ Nivel de PTH
  • ↑ Ca CA Condylomata acuminata are a clinical manifestation of genital HPV infection. Condylomata acuminata are described as raised, pearly, flesh-colored, papular, cauliflower-like lesions seen in the anogenital region that may cause itching, pain, or bleeding. Condylomata Acuminata (Genital Warts)2+ sérico
  • ↑ O niveles normales de fosfato

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Bone Metabolism Case: 68-year-old Woman with High Serum Calcium Level

Tratamiento

Hiperparatiroidismo primario

Tratamiento médico:

  • Indicaciones:
    • Para pacientes asintomáticos
    • Para los LOS Neisseria pacientes que no son candidatos a la cirugía
  • Agentes calcimiméticos (activan el receptor Receptor Receptors are proteins located either on the surface of or within a cell that can bind to signaling molecules known as ligands (e.g., hormones) and cause some type of response within the cell. Receptors sensor de Ca CA Condylomata acuminata are a clinical manifestation of genital HPV infection. Condylomata acuminata are described as raised, pearly, flesh-colored, papular, cauliflower-like lesions seen in the anogenital region that may cause itching, pain, or bleeding. Condylomata Acuminata (Genital Warts)2+)
  • Profilaxis de la osteoporosis Osteoporosis Osteoporosis refers to a decrease in bone mass and density leading to an increased number of fractures. There are 2 forms of osteoporosis: primary, which is commonly postmenopausal or senile; and secondary, which is a manifestation of immobilization, underlying medical disorders, or long-term use of certain medications. Osteoporosis con bifosfonatos
  • Fomentar la actividad física para disminuir la resorción ósea.
  • Fomentar la hidratación adecuada (para prevenir los LOS Neisseria cálculos renales).
  • Evitar ciertos medicamentos (litio, diuréticos tiazídicos).
  • Mantener una ingesta adecuada de vitamina D.

Cirugía:

  • Indicaciones:
    • Todos los LOS Neisseria casos sintomáticos
    • Casos asintomáticos con ciertos criterios:
      • Deterioro de la función renal, nefrolitiasis o nefrocalcinosis
      • Densidad ósea reducida
      • Ca CA Condylomata acuminata are a clinical manifestation of genital HPV infection. Condylomata acuminata are described as raised, pearly, flesh-colored, papular, cauliflower-like lesions seen in the anogenital region that may cause itching, pain, or bleeding. Condylomata Acuminata (Genital Warts) sérico ≥ 1.0 mg/dL (0,25 mmol/L) por arriba del límite superior normal
      • < 50 años de edad
  • Localización preoperatoria:
    • Se necesita para:
      • Abordaje mínimamente invasivo/unilateral
      • Reoperación por hiperparatiroidismo recurrente/persistente
    • Estudios de imagen:
      • Gammagrafía con sestamibi (tecnecio-99m metoxiisobutilisonitrilo)
      • Ultrasonido
      • TC de 4 dimensiones
      • RM
    • Estudios invasivos:
      • Muestreo venoso selectivo
      • Arteriografía selectiva
  • Procedimientos quirúrgicos:
      • Extirpación de una glándula paratiroidea específica si se identifica el tumor Tumor Inflammation de forma fiable
      • Carcinoma paratiroideo: paratiroidectomía con tiroidectomía ipsilateral y resección en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum bloque de todo el tejido invadido por el tumor Tumor Inflammation
    Parathyroid adenoma with cystic internal change

    Adenoma paratiroideo (flecha) con cambio quístico:
    El tumor se extiende hasta el surco traqueo-esofágico derecho.

    Imagen: “3-phase dual-energy CT scan as a feasible salvage imaging modality for the identification of non-localizing parathyroid adenomas: a prospective study” por Roskies, M., et al. Licencia: CC BY 4.0
    Sestamibi parathyroid scintigraphy

    La gammagrafía paratiroidea con sestamibi reveló un aumento de la captación focal compatible con un adenoma paratiroideo en el polo inferior izquierdo de la glándula tiroides

    Imagen: “Serial pathologic fractures of five long bones on four separate occasions in a patient with primary hyperparathyroidism, challenges of management in a developing country: a case report” por Olatoke, S.A., et al. Licencia: CC BY 2.0
    Giant parathyroid adenoma with crossection and microscopic view

    a: Adenoma paratiroideo gigante tras su resección y fijación en formol
    b: Secciones transversales de la masa multiloculada
    c: Vista microscópica de bajo poder de las células adenomatosas en la parte superior derecha de la fotografía, adyacente al tejido fibroso grueso de color rosa; un pequeño grupo de tejido glandular tiroideo normal comprimido está en la esquina inferior izquierda.

    Imagen: “Acute presentation of a giant intrathyroidal parathyroid adenoma: a case report” por Journal of Medical Case Reports. Licencia: CC BY 4.0

    Hiperparatiroidismo secundario y terciario

    Tratamiento médico:

    • Tratamiento de la enfermedad subyacente
    • Suplementación con vitamina D
    • Restricción dietética de fósforo y aglutinantes de fósforo
    • Calcimiméticos
    • Hiperparatiroidismo terciario: paratiroidectomía total o subtotal

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    Diagnóstico Diferencial

    • Malignidad:La hipercalcemia no es infrecuente en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum las neoplasias malignas, especialmente en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria estadios más avanzados. La hipercalcemia maligna suele ser más grave que en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el hiperparatiroidismo primario. El manejo depende principalmente del tratamiento de la enfermedad subyacente.
    • Hipercalcemia hipocalciúrica familiar (FHH, por sus siglas en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum inglés): trastorno autosómico dominante caracterizado por una leve hipercalcemia, una elevación leve de la PTH y un Ca CA Condylomata acuminata are a clinical manifestation of genital HPV infection. Condylomata acuminata are described as raised, pearly, flesh-colored, papular, cauliflower-like lesions seen in the anogenital region that may cause itching, pain, or bleeding. Condylomata Acuminata (Genital Warts) urinario bajo: la hipercalcemia hipocalciúrica familiar está causada por una mutación inactivadora del receptor Receptor Receptors are proteins located either on the surface of or within a cell that can bind to signaling molecules known as ligands (e.g., hormones) and cause some type of response within the cell. Receptors sensor de Ca CA Condylomata acuminata are a clinical manifestation of genital HPV infection. Condylomata acuminata are described as raised, pearly, flesh-colored, papular, cauliflower-like lesions seen in the anogenital region that may cause itching, pain, or bleeding. Condylomata Acuminata (Genital Warts) en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum las glándulas paratiroides y los LOS Neisseria riñones. Esta afección suele presentarse con una hipercalcemia asintomática leve y se distingue del hiperparatiroidismo primario por el bajo nivel de Ca CA Condylomata acuminata are a clinical manifestation of genital HPV infection. Condylomata acuminata are described as raised, pearly, flesh-colored, papular, cauliflower-like lesions seen in the anogenital region that may cause itching, pain, or bleeding. Condylomata Acuminata (Genital Warts) en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum orina. Esta afección benigna no suele requerir tratamiento.
    • Medicamentos: ciertos medicamentos pueden afectar al AL Amyloidosis metabolismo del Ca CA Condylomata acuminata are a clinical manifestation of genital HPV infection. Condylomata acuminata are described as raised, pearly, flesh-colored, papular, cauliflower-like lesions seen in the anogenital region that may cause itching, pain, or bleeding. Condylomata Acuminata (Genital Warts) y causar hipercalcemia, sobre todo el litio y los LOS Neisseria diuréticos tiazídicos. El litio puede desenmascarar adenomas preexistentes en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum pacientes a los LOS Neisseria pocos años de su uso, y puede inducir enfermedad paratiroidea multiglandular con el uso crónico. Los LOS Neisseria diuréticos tiazídicos reducen la excreción urinaria de Ca CA Condylomata acuminata are a clinical manifestation of genital HPV infection. Condylomata acuminata are described as raised, pearly, flesh-colored, papular, cauliflower-like lesions seen in the anogenital region that may cause itching, pain, or bleeding. Condylomata Acuminata (Genital Warts). La hipercalcemia suele desaparecer tras la interrupción del tratamiento.

    Referencias

    1. Bilezikian JP, et al. (2014). Guidelines for the management of asymptomatic primary hyperparathyroidism: summary statement from the Fourth International Workshop. J Clin Endocrinol Metab 99:3561-3569. https://pubmed.ncbi.nlm.nih.gov/25162665/
    2. Fuleihan GE, Silverberg SJ. (2020). Primary hyperparathyroidism: diagnosis, differential diagnosis, and evaluation. Retrieved February 6, 2021, from https://www.uptodate.com/contents/primary-hyperparathyroidism-diagnosis-differential-diagnosis-and-evaluation
    3. Fuleihan GE, Silverberg SJ. (2019). Primary hyperparathyroidism: clinical manifestations. Retrieved February 6, 2021, from https://www.uptodate.com/contents/primary-hyperparathyroidism-clinical-manifestations
    4. Fuleihan GE, Arnold A. (2020). Pathogenesis and etiology of primary hyperparathyroidism. Retrieved February 6, 2021, from https://www.uptodate.com/contents/pathogenesis-and-etiology-of-primary-hyperparathyroidism
    5. Kim L. (2020). Hyperparathyroidism. Retrieved February 6, 2021, from https://emedicine.medscape.com/article/127351-overview#a4
    6. Silverberg SJ, Fuleihan GE. (2019). Primary hyperparathyroidism: management. Retrieved February 6, 2021, from https://www.uptodate.com/contents/primary-hyperparathyroidism-management
    7. Maitra A. (2020). Hyperthyroidism. En Kumar V, Abbas AK, Aster JC (Eds.). Robbins & Cotran Pathologic Basis of Disease, 10th ed., pp. 354-355.

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