Hyperparathyroidism

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

Intestine Stimulates calcium absorption by promoting the

conversion of vitamin D to its active metabolite in the kidney

Primary – Adenoma, Hyperplasia or carcinoma Secondary – In renal diseae Tertiary – When secondary hyperplasia leads to

autonomous overactivity

Pathology Hypercalcemia Hypercalciuria Hyperphosphoturia Kidney:Calcinosis,stone formation,recurrent

infection and impaired function

General loss of bone substance Subperiosteal erosion Endosteal cavitation Osteit is f ibrosa 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

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

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

Hypercalcemia Hypophosphataemia Raised PTH Raised serum alkaline phosphatase

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

Exclusion of other causes of hypercalcemia like mult iple myeloma,metastatic disease,sarcoidosis in which PTH levels are usually are depressed

All types of osteoporosis and osteomalacia

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

Postoperative severe hypocalcemia due to brisk formation of new bone

Must be treated promptly with fast acting vit D metabolites

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

< 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

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

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