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Hyperparathyroidism

Hyperparathyroidism is a topic covered in the 5-Minute Emergency Consult.

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Basics

Description

Parathyroid hormone (PTH) excess with symptoms owing to PTH actions:
- Decreases urinary Ca²⁺ loss
- Increases urinary PO₄²⁻ loss
- Stimulates vitamin D conversion from 25(OH)-D to 1,25(OH)-D in kidney
- Liberates Ca²⁺ and PO₄²⁻ from bone
- Hypercalcemia is the primary metabolic finding
Hypercalciuria from hypercalcemia (despite decreased urinary loss) produces increased magnesium loss in urine
Magnesium (negative feedback to prevent hypercalcemia causes hypomagnesaemia):
- Cofactor in the production of PTH
- Essential for action of PTH in target tissues
Genetics:
- Associated with multiple endocrine neoplasia type 1:
  - Hyperparathyroidism
  - Pancreatic islet disease
  - Pituitary disease
- Associated with multiple endocrine neoplasia type 2:
  - Hyperparathyroidism (type 2A, rare in 2B)
  - Medullary carcinoma of the thyroid (type 2A and 2B, less virulent in type 2A)
  - Pheochromocytoma (type 2A and 2B)
  - Mucosal neuroma (type 2B)

Etiology

Excess secretion of PTH owing to:
- Primary hyperparathyroidism (adenoma 85%, hyperplasia 14%, carcinoma <1%)
- Secondary hyperparathyroidism (response to vitamin D deficiency or chronic renal failure with hyperphosphatemia):
  - Calcium is low or normal, but PTH levels are elevated

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Citation

Barkin, Adam Z., et al., editors. "Hyperparathyroidism." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307160/all/Hyperparathyroidism.

Hyperparathyroidism. In: Barkin AZ, Barkin RM, Hayden SR, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307160/all/Hyperparathyroidism. Accessed February 19, 2019.

Hyperparathyroidism. (2016). In Barkin, A. Z., Barkin, R. M., Hayden, S. R., Rosen, P., Schaider, J. J., Shayne, P., & Wolfe, R. E. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307160/all/Hyperparathyroidism

Hyperparathyroidism [Internet]. In: Barkin AZ, Barkin RM, Hayden SR, Rosen P, Schaider JJ, Shayne P, Wolfe RE, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 February 19]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307160/all/Hyperparathyroidism

* When formatting your citation, note that all book, journal, and database titles should be italicized* Article titles in AMA citation format should be in sentence-case

TY - ELEC T1 - Hyperparathyroidism ID - 307160 ED - Barkin,Adam Z, ED - Barkin,Roger M, ED - Hayden,Stephen R, ED - Rosen,Peter, ED - Schaider,Jeffrey J, ED - Shayne,Philip, ED - Wolfe,Richard E, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307160/all/Hyperparathyroidism PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -