Primary hyperparathyroidism

Primary hyperparathyroidism 

Updated: 02/05/2024

© Jun Wang, MD, PhD

Definition
  • Autonomous overproduction of parathyroid hormone
General features
Key pathogenesis
  • Autonomous overproduction of parathyroid hormone
  • Subsequent activation of osteoclast
Clinical presentations
  • May be asymptomatic
  • Incidental finding of hypercalcemia
  • Associated with hypercalcemia and excessive calcium resorption
  • Bones: Osteoporosis, osteitis fibrosa cystica (brown tumor)
  • Stones: Renal calcium stones, nephrocalcinosis
  • Abdominal groans: Nausea, peptic ulcers (associated with high serum gastrin caused by hypercalcemia), constipation, pancreatitis, gallstones
  • Psychic moans: Depression, lethargy, seizures
  • Others: Proximal myopathy, Weakness, fatigue, calcifications
Key laboratory findings
  • Hypercalcemia, although may be normocalcemic
  • Inappropriately elevated levels of PTH
  • Low serum phosphorus, high serum alkaline phosphatase, high urine calcium and phosphorus
  • If low urine calcium but hypercalcemia, consider familial hypocalciuric hypercalcemia
    • Calcium sensing receptor mutation
    • Reduced sensitivity to serum calcium
    • Higher level of serum calcium to suppress PTH secretion
    • Low excretion faction of calcium, causing low urine calcium 
    • Usually asymptomatic, but may present with non specific symptoms, including fatigue, polyuria, polydipsia, and abnormal renal function
Key radiologic features
Osteitis fibrosa cystica
Treatment
  • Surgery

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