- Clinical bone disease occurs in less than half of the patients with hyperparathyroidism.
- Hyperparathyroidism tends to present either with bone disease or with renal stones, but not both.
Parathyroid hormone and bone:
- The parathyroid hormone acts directly on the bone.
- Release calcium into the extra-cellular fluid by stimulating osteoclastic resorption.
- The hyperparathyroidism may be classified as:
- Primary: Due to adenoma of the parathyroid.
- Secondary: Due to persistent hypocalcemia, e.g. renal rickets.
- Tertiary:The secondary hyperplasia remains and becomes autonomous.
- All types are associated with excessive secretion of parathormone.
- Age: 3rd to 5th decade
- Male: Female ratio 1:3
Common presenting complaints:
1. Bone pains
2. Pathological fracture:
- Common sites of fractures are dorso-lumbar spine, neck of the femur and pubic rami.
3. Brown’s tumour:
4. Anorexia, nausea, vomiting and abdominal cramps
5. Renal colics with haematuria, because of renal calculus
1. In the Hand
- Classical subperiosteal cortical resorption of the middle phalanges.
2. In the Spine
- Biconcave vertebral body due to the bulging of the disk, ‘Cod fish spine’.
3. In the Long Bones
- Generalized rarefaction with cystic lesions
- osteitis fibrosa cystica and brown tumors.
4. In the Skull
- Stippling calcification.
- ‘Pepper pot skull’ (also known as salt pepper appearance).
- Elevated serum calcium, low serum phosphorus.
- Elevated serum alkaline phosphatase.
- Elevated serum parathormone levels.
- It consists of:
- removal of the basic cause
- orthopaedic treatment
- urologic treatment.
- Most common cause of hyperparathyroidism is Adenoma.
- A common cause of Primary hyperparathyroidism is Solitary parathyroid adenoma.
- Chronic renal failure is associated with secondary hyperparathyroidism.
- Secondary hyperparathyroidism due to Vit D deficiency shows Hypophosphatemia.
- Tertiary hyperparathyroidism is Secondary hyperparathyroidism with chief cell adenoma.
- Subtle presentation of hyperparathyroidism is Asymptomatic hypercalcemia.
- Pathognomic feature of hyperparathyroidism is Sub periosteal resoption of phalynges.
- Characteristic subperiosteal bone resorption in Hyperparathyroidism is best seen at Radial border of middle phalanx.
- Salt-pepper skull is a feature of primary hyperparathyroidism.
- Osteitis fibrosa cystica is seen with Primary hyperparathyroidism.
- Brown tumor is seen in Hyperparathyroidism.
- Absence of lamina dura seen in Hyperparathyroidism.
- Floating teeth is seen in Hyperparathyroidism.
- Increased plasma concentration of calcium is associated with Primary hyperparathyroidism.
- The initial treatment of choice for secondary hyperparathyroidism in renal osteodystrophy is Phosphate binders.
- Adenoma is the most common surgically repairable cause of hyperparathyroidism.
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