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It's pathological increase in parathyroid hormone secretion.

  • It's more more common in female 3:1

Aetiology:


The most common cause is parathyroid adenoma and rarely to be adenocarcinoma.

  • Usually occur in one parathyroid gland and rarely adenoma occur in the four glands.

Pathogenesis:

Increase in parathyroid hormone result in the following:

  • increase plasma Ca (hypercalcemia)
  • decrease plasma phosphate(Po4)
Increase in the plasma Ca(hypercalcemia):
1-high Ca precipitate in the kidneys result

  • Recurrent renal stones
  • Urinary tract infections
  • Renal failure
2-peptic ulcer (because high Ca activate gastrin secretion in the stomach result lead to high HCL)
3-pancreatitis(high Ca activate the pancreatic enzymes within the pancrease result in in its digestion)
4-Hypertension(because parathyroid hormone increase the sensitivity of arterioles to catecholeamines)
5-Constipation (high Ca decrease the excitability of smooth muscles )
5-Mental confusion(high Ca decrease the excitability of neurons)
7-pathological fracture (this occur late in the disease as the parathormone activate the soteoclast result in bone resorption and become depleted from Ca)

decrease in phosphate result in
Muscles weakness due to depletion of phosphate needed for ATP synthesis.


Clincal picture:


1-Abdominal pain (pancreatisis , peptic ulcer)
2-kidney(recurrent renal stones, UTIs, renal failure)
3-mental confusion
4-muscle weakness
5-pathological fracture

Investigations:


1-increased parathyroid hormone level
2-increased serum Ca
3-Decreased serum phosphate
4-increased Ca in urine
5-increased phosphate in urine
6-Increased serum alkaline phosphatase(SAP) of the bone
7-X-ray
Show Subperiosteal bone resorption.

Treatment:

Surgical removal of adenoma is definite treatment


Medical treatment of emergency hypercalcemia:


  • iv saline.
  • calcium restriction.
  • loop diuretics.

Notes


  • ⇨if serum phosphate rise in hyperparathyroid patient suspect renal failure.
  • Digitalis should be avoided because high Ca increase its toxicity.give Beta blocker if arrhythmia developed
  • if you found neck mass in hypothyroid patient its more likely to be co-associated thyroid adenoma.





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