Hyperparathyroidism
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Hyperparathyroidism
Endocrine system
Adrenal gland disorders
Congenital adrenal hyperplasia
Primary adrenal insufficiency
Waterhouse-Friderichsen syndrome
Hyperaldosteronism
Adrenal cortical carcinoma
Cushing syndrome
Conn syndrome
Thyroid gland disorders
Thyroglossal duct cyst
Hyperthyroidism
Graves disease
Thyroid eye disease (NORD)
Toxic multinodular goiter
Thyroid storm
Hypothyroidism
Euthyroid sick syndrome
Hashimoto thyroiditis
Subacute granulomatous thyroiditis
Riedel thyroiditis
Postpartum thyroiditis
Thyroid cancer
Parathyroid gland disorders
Hyperparathyroidism
Hypoparathyroidism
Hypercalcemia
Hypocalcemia
Pancreatic disorders
Diabetes mellitus
Diabetic retinopathy
Diabetic nephropathy
Pituitary gland disorders
Hyperpituitarism
Pituitary adenoma
Hyperprolactinemia
Prolactinoma
Gigantism
Acromegaly
Hypopituitarism
Growth hormone deficiency
Pituitary apoplexy
Sheehan syndrome
Hypoprolactinemia
Constitutional growth delay
Diabetes insipidus
Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
Gonadal dysfunction
Precocious puberty
Delayed puberty
Premature ovarian failure
Polycystic ovary syndrome
Androgen insensitivity syndrome
Kallmann syndrome
5-alpha-reductase deficiency
Polyglandular syndromes
Autoimmune polyglandular syndrome type 1 (NORD)
Endocrine tumors
Multiple endocrine neoplasia
Pancreatic neuroendocrine neoplasms
Zollinger-Ellison syndrome
Carcinoid syndrome
Pheochromocytoma
Neuroblastoma
Opsoclonus myoclonus syndrome (NORD)
Endocrine system pathology review
Adrenal insufficiency: Pathology review
Adrenal masses: Pathology review
Hyperthyroidism: Pathology review
Hypothyroidism: Pathology review
Thyroid nodules and thyroid cancer: Pathology review
Parathyroid disorders and calcium imbalance: Pathology review
Diabetes mellitus: Pathology review
Cushing syndrome and Cushing disease: Pathology review
Pituitary tumors: Pathology review
Hypopituitarism: Pathology review
Diabetes insipidus and SIADH: Pathology review
Multiple endocrine neoplasia: Pathology review
Neuroendocrine tumors of the gastrointestinal system: Pathology review
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Hyperparathyroidism
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Hyperparathyroidism
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Routine blood work is performed. Which of the following sets of findings will most likely be seen in this patient?
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Abdominal pain
hyperparathyroidism p. 344
Acute pancreatitis p. 406
hyperparathyroidism p. 344
Alkaline phosphatase (ALP) p. 399, 473
hyperparathyroidism and p. 344
cAMP (cyclic adenosine monophosphate)
hyperparathyroidism p. 344
Depression
hyperparathyroidism p. 344
Hypercalcemia p. 615
hyperparathyroidism p. 344
Hypercalciuria
hyperparathyroidism p. 344
Hyperparathyroidism p. 344
associations p. 729
calcium pyrophosphate deposition disease p. 477
cinacalcet for p. 363
lab findings p. 722
lab values in p. 472
osteoporosis p. 472
renal osteodystrophy and p. 628
Hyperphosphatemia p. 615
hyperparathyroidism (secondary) p. 344
Hypocalcemia p. 337, 615
hyperparathyroidism p. 344
Hypophosphatemia p. 615
hyperparathyroidism p. 344
Kidney stones p. 626
hyperparathyroidism p. 344
Pancreatitis p. 406
hyperparathyroidism as cause p. 344
Parathyroid adenomas
hyperparathyroidism caused by p. 344
Parathyroid hormone (PTH) p. 336
in hyperparathyroidism p. 344
Polyuria p. 624
hyperparathyroidism p. 344
Tertiary hyperparathyroidism p. 344
Vitamin D deficiency p. 350
hyperparathyroidism p. 474
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Transcript
Content Reviewers
Rishi Desai, MD, MPHContributors
Brittany Norton, MFA
Marisa Pedron
Tanner Marshall, MS
With hyperparathyroidism, “hyper” refers to over, and “parathyroid” refers to the parathyroid glands, so hyperparathyroidism refers to a condition where there is an overproduction of parathyroid hormone.
Parathyroid hormone comes from the parathyroid glands which are buried within the thyroid gland, and their main job is to keep blood calcium levels stable.
Now, the majority of the extracellular calcium, the calcium in the blood and interstitium, is split almost equally between two groups - calcium that is diffusible and calcium that is not diffusible.
Diffusible calcium is small enough to diffuse across cell membranes and is separated into two subcategories.
The first is free-ionized calcium, which is involved in all sorts of cellular processes like neuronal action potentials, contraction of skeletal, smooth, and cardiac muscle, hormone secretion, and blood coagulation, all of which are tightly regulated by enzymes and hormones.
The second category is complexed calcium, which is where the positively charged calcium is ionically linked to tiny negatively charged molecules like oxalate, which is a small anion that are normally found in our blood in small amounts.
The complexed calcium forms a molecule that’s electrically neutral but unlike free-ionized calcium it’s not useful for cellular processes.
Both of these are called diffusible because they’re small enough to diffuse across cell membranes.
Finally there’s the non-diffusible calcium which is bound to negatively charged proteins like albumin.
The resulting protein-calcium complex is too large and charged to cross membranes, leaving this calcium also uninvolved in cellular processes.
Changes in the body’s levels of extracellular calcium are detected by a surface receptor in parathyroid cells that’s called the calcium-sensing receptor.
These changes affect the amount of parathyroid hormone that’s released by the parathyroid gland.
Summary
Hyperparathyroidism is a condition in which the parathyroid glands produce too much parathyroid hormone (PTH), which regulates calcium levels in the blood. Hyperparathyroidism can be primary, secondary, or even tertiary.
Primary hyperparathyroidism usually results from PTH secretion by a parathyroid adenoma. It is characterized by excess PTH that leads to high blood calcium levels (hypercalcemia), bone mass loss, kidney stones, and other health problems, such as psychiatric issues.
Secondary hyperparathyroidism develops when there are conditions like chronic kidney disease, which can lead to low calcium, high phosphate, and low vitamin D levels. It is mainly characterized by osteodystrophy, in which there is bone weakening associated with bone pain and deformation.
Finally, there is tertiary hyperparathyroidism, which occurs because of chronic secondary hyperparathyroidism from kidney disease. This leads to hypercalcemia and phosphate imbalances.
Sources
- "Robbins Basic Pathology" Elsevier (2017)
- "Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2)" McGraw-Hill Education / Medical (2018)
- "Pathophysiology of Disease: An Introduction to Clinical Medicine 8E" McGraw-Hill Education / Medical (2018)
- "CURRENT Medical Diagnosis and Treatment 2020" McGraw-Hill Education / Medical (2019)
- "Harrison's Endocrinology, 4E" McGraw-Hill Education / Medical (2016)
- "Vitamin D Deficiency and Secondary Hyperparathyroidism in the Elderly: Consequences for Bone Loss and Fractures and Therapeutic Implications" Endocrine Reviews (2001)
- "Calcimimetics for secondary hyperparathyroidism in chronic kidney disease patients" Cochrane Database of Systematic Reviews (2014)
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