Primary Hyperparathyroidism & Effects of Hyperparathyroidism

by Carlo Raj, MD

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    Let’s take a look at primary hyperparathyroidism in greater detail. We said that extremely, if it’s hypocalcaemia 90 percent of your patients if you’re thinking about adenoma, which is exactly what we’re seeing here in the picture, an adenoma within your parathyroid gland. Solitary, sporadic 85 percent of the time. It’s seen on a scan known as your Sestamibi Scan and the darkened area that you see there will be a solitary adenoma in which it’s extremely darkened and enlarged. Focus upon your Sestamibi Scan. 10 to 15 percent hyperplasia of all four glands and majority of your primary hyperparathyroidism would be a solitary adenoma as seen here in the scan; 10 to 15 percent might be hyperplasia of all four glands. Perhaps carcinoma, paraneoplastically, squamous and renal-renal cell carcinoma, how will this then produce your hypoparathyroidism? PTHrp, so ectopic production of PTHrp resulting in hypercalcemia where your PTH is actually depressed. Risk factors, irradiation to head and neck; usually asymptomatic, diagnosed routine labs. Typical symptoms, if you’re thinking about hypercalcemia, would not be tetany; fatigue, nausea, constipation… looking at GI symptoms and you’re looking at neurologic issues as well. Dizziness, fatigue, worst case scenario might even be stupor and coma. If it’s hyperparathyroidism, you take a look at the bone and its being broken down… bone resorption. PTH does not promote bone mineralization, it promotes resorption of calcium from the bone. Thus, in the X-ray that we’re seeing is our areas of the bone where it’s extremely lucent, not opaque. Remember, if it’s osteopetrosis, if it’s Paget’s disease of the bone, especially the third pattern, triphasic, you would have increased bone. You’ve heard of marble bone disease, that’s-that’s opaque, extremely white, so lucent. What may then happen with extreme destruction of the bone and such, obviously fractures and worst...

    About the Lecture

    The lecture Primary Hyperparathyroidism & Effects of Hyperparathyroidism by Carlo Raj, MD is from the course Parathyroid Gland Disorders.

    Included Quiz Questions

    1. Solitary adenoma
    2. Carcinoma
    3. Hyperplasia of all 4 glands
    4. Renal cell carcinoma
    5. Squamous cell carcinoma of the lung
    1. Tetany
    2. Constipation
    3. Fatigue
    4. Asymptomatic
    5. Nausea
    1. Osteitis fibrosis cystica
    2. Osteopetrosis
    3. Paget's Disease of the bone
    4. Osteomalacia
    5. Pathologically increased bone mineralization
    1. Uric acid kidney stones
    2. Gallstones
    3. Acute pancreatitis
    4. Seizures
    5. Polyuria

    Author of lecture Primary Hyperparathyroidism & Effects of Hyperparathyroidism

     Carlo Raj, MD

    Carlo Raj, MD

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