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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

Rosen, Peter, 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: Rosen P, Shayne P, Barkin AZ, 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 April 26, 2019.
Hyperparathyroidism. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307160/all/Hyperparathyroidism
Hyperparathyroidism [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 26]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307160/all/Hyperparathyroidism.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Hyperparathyroidism ID - 307160 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, 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 -