Hypoparathyroidism Hyperparathyroidism
Definition too little PTH produced from the parathyroid gland Definition too much PTH is produced (stereotypically older females)
Classification Classification
Type Cause
Type Cause
80% solitary adenoma; 15%
Congenital DiGeorge syndrome
Primary hyperplasia; 4% multiple adenoma;
Acquired Complication of parathyroidectomy/thyroidectomy 1% carcinoma
Transient Neonates born prematurely Secondary
PseudohypoPTH targeted cells insensitive to PTH PTH hyperplasia as a result of low calcium, Vitamin D deficiency, CKD
Low IQ, short stature, short 4th + 5th metacarpals always in a setting of chronic renal failure
Inherited
PseudopseudohypoPTH similar phenotype but normal Tertiary
biochemical Occurs as a result of on-going hyperplasia
of PTH glands after correction of underlying Prolonged secondary hyperPTH
Signs + symptoms (secondary to hypocalcaemia) renal disorder, hyperplasia of all 4 glands is
Tetany, muscle twitching, cramping + spasm usually the cause
Perioral anaesthesia
Trousseau’s sign carpal spasm if brachial artery occluded by inflating BP cuff + Signs + symptoms ‘bones, stones, abdominal groans + psychic moans’
maintaining pressure > systolic Polydipsia, polyuria
Chovstek’s sign tapping over parotid causes facial muscles to twitch Peptic ulceration, constipation, pancreatitis
Chronic depression, cataracts Bone pain/fracture
ECG prolonged QT interval Renal stones, depression, HTN
Secondary: osteomalacia, rickets, renal osteodystrophy
PseudohypoP
HypoPTH PseudopseudoPTH
TH
Primary Secondary Tertiary
↓ ↑
PTH level Normal
PTH level ↑ ↑ ↑
↓ ↓ Serum calcium ↑ ↓ ↑
Serum calcium Normal
Serum phosphate ↓ ↑ ↓
↑ ↑
Serum phosphate Normal
Bloods
Urine calcium levels
Bloods FBC, U&Es, LFTs, creatinine, urea DEXA scan
ECG Arrhythmias Radiology: USS of kidneys + neck, XR, PTH gland biopsy
ECHO structural defects (DiGeorge syndrome) Mx
Radiology plain XR of hand Primary
Indications for surgery:
Hypercalcaemia Mx Elevated serum calcium > 1mg/dL above normal, Hypercalciuria, nephrolithiasis, age <
Rehydration w/ normal saline, typically 3-4L/day 50 yrs, neuromuscular Sx, DEXA (T score < -2.5)
Following rehydration bisphosphonates may be used 2-3 days to work; max. seen @ 7 Medical: Bisphosphonates
days Secondary
Other options include: Indications for surgery: persistent pruritus, bone pain, soft tissue calcification
Calcitonin Medical: Calcimimetics e.g. Cincalcet
Steroids in Sarcoidosis Tertiary
Hypocalcaemia Mx Allow 12 months to elapse
IV replacement IV calcium gluconate, 10ml of 10% solution over 10 minutes
IV calcium chloride is more likely to cause local irritation
ECG monitoring
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