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Revision as of 15:11, 26 November 2006 by (Talk)

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Hyperparathyroidism is overactivity of the parathyroid glands resulting in inappropriately high production of parathyroid hormone (PTH).

1 Etiology and pathophysiology

  • Primary hyperparathyroidism results from a dysfunction in the parathyroid glands themselves, with oversecretion of PTH. It is usually caused by parathyroid adenomas that lose their sensitivity to circulating calcium levels. Here, usually, only one of the four parathyroid glands is affected. A less common cause is from multiple endocrine neoplasia (MEN) where usually all four glands are affected.
  • Tertiary, quartary and quintary hyperparathyroidism are rare forms that are caused by long lasting disorders of the calcium feedback control system.

2 Signs and symptoms

The majority of patients with hyperparathyroidism are asymptomatic. Manifestations of hyperparathyroidism usually involve the kidney (stones) and the skeletal system (bone pain due to fibrous tissue replacement, termed osteitis fibrosa cystica)

If symptomatic, hyperparathyroidism can be classically remembered by the rhyme "moans" (myalgia), "groans" (abdominal pain), "stones" (kidney), "bones" (bone pain), and "psychiatric overtones" (confusion, altered mental state, lethargy, fatigue).

Other symptoms include: headaches, sleep disorders, memory problems, gastroesophageal reflux, decreased sex drive, thinning hair, hypertension, and heart palpitations.

3 Diagnosis

The gold standard of diagnosis is the PTH immunoassay. Once an elevated PTH has been confirmed, goal of diagnosis is to determine whether the hyperparathyroidism is primary or secondary in origin by obtaining a serum calcium level. If the calcium level is high, then the diagnosis is very likely primary hyperparathyroidism; if low or normal, then it is most likely secondary hyperparathyroidism.

4 Treatment

Treatment is first and foremost directed at hypercalcemia, if symptomatic. (see hypercalcemia)

If asymptomatic, treatment can then be directed towards the underlying cause

5 External links

This page was last edited on 26 November 2006, at 20:44.

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