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Encyclopedia > Hyperparathyroidism
Hyperparathyroidism
Classification & external resources
Thyroid and parathyroid.
ICD-10 E21.
ICD-9 252.0
DiseasesDB 20710
eMedicine emerg/265 
MeSH D006961

Hyperparathyroidism is overactivity of the parathyroid glands resulting in excess production of parathyroid hormone (PTH). It was first described and treated in the 1930s by Fuller Albright of Massachusetts General Hospital, working at the Mallinckrodt General Clinical Research Center. Image File history File links Illu_thyroid_parathyroid. ... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following codes are used with International Statistical Classification of Diseases and Related Health Problems. ... // E00-E35 - Endocrine diseases (E00-E07) Disorders of thyroid gland (E00) Congenital iodine-deficiency syndrome (E01) Iodine-deficiency-related thyroid disorders and allied conditions (E02) Subclinical iodine-deficiency hypothyroidism (E03) Other hypothyroidism (E030) Congenital hypothyroidism with diffuse goitre (E031) Congenital hypothyroidism without goitre (E032) Hypothyroidism due to medicaments and other... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... The Disease Bold textDatabase is a free website that provides information about the relationships between medical conditions, symptoms, and medications. ... eMedicine is an online clinical medical knowledge base that was founded in 1996. ... Medical Subject Headings (MeSH) is a huge controlled vocabulary (or metadata system) for the purpose of indexing journal articles and books in the life sciences. ... The four human parathyroid glands are adjacent to the thyroid. ... Parathyroid hormone (PTH) is secreted by the parathyroid glands as a polypeptide containing 84 amino acids. ... Massachusetts General Hospital (often abbreviated to Mass General or just MGH) is a teaching hospital of Harvard Medical School and biomedical research facility in Boston, Massachusetts. ... The Mallinckrodt MGH General Clinical Research Center (GCRC) is a research center at Massachusetts General Hospital. ...

Contents

Presentation

In cases of primary, tertiary and quintary hyperparathyroidism increased PTH consequently leads to increased serum calcium (hypercalcemia) due to: Hypercalcaemia is an elevated calcium level in the blood. ...

  1. increased bone resorption, allowing flow of calcium from bone to blood
  2. reduced renal clearance of calcium
  3. increased intestinal calcium absorption

By contrast, in secondary and quartary hyperparathyroidism effectiveness of PTH is reduced. Alkaline phosphatase levels are elevated in all types of hyperparathyroidism. Ball and stick model of alkaline phosphatase Alkaline phosphatase (ALP) (EC 3. ...


In primary hyperparathyroidism, serum phosphorus levels are abnormally low as a result of decreased renal tubular phosphorus reabsorption. This contrasts with secondary hyperparathyroidism, in which serum phosphorus levels are generally elevated because of renal disease.


Etiology

  • Primary hyperparathyroidism results from a dysfunction in the parathyroid glands themselves, with oversecretion of PTH.
    • The most common cause is a benign parathyroid adenoma that loses its sensitivity to circulating calcium levels. Usually, only one of the four parathyroid glands is affected.
    • A less common cause is from multiple endocrine neoplasia (MEN).
  • Tertiary, quartary and quintary hyperparathyroidism are rare forms that are caused by long lasting disorders of the calcium feedback control system.

Primary hyperparathyroidism causes hypercalcemia (elevated blood calcium levels) through the excessive secretion of parathyroid hormone (PTH), usually by an adenoma (benign tumors) of the parathyroid glands. ... Multiple endocrine neoplasia (MEN) (or multiple endocrine adenomas, or multiple endocrine adenomatosis -- MEA) consists of three syndromes featuring tumors of endocrine glands, each with its own characteristic pattern. ... Secondary hyperparathyroidism refers to the excessive secretion of parathyroid hormone (PTH) by the parathyroid glands in response to hypocalcemia (low blood calcium levels) and associated hypertrophy of the glands. ... Renal osteodystrophy is a bone pathology, characterized by defective mineralization, that results from renal disease. ... Tertiary hyperparathyroidism is a state of excessive secretion of parathyroid hormone (PTH) after a long period of secondary hyperparathyroidism and resulting in hypercalcemia. ...

Signs and symptoms

Many patients presenting with hyperparathyroidism will have no signs or symptoms, with diagnosis being made on futher investigation after a conincidental finding of hypercalcemia. It is, however, reported that many patients will report that they feel better after treatment for hyperparathyroidism. Of those patient that do present with symptoms, they are commonly associated with the effects of an increased level of calcium.


Since calcium is responsible for the electical conduction within our nervous system, high blood calcium levels have a direct effect on the nervous system. Thus, most of the symptoms of parathyroid disease are "neurologic" in origin. The most common symptom is fatigue and tiredness. Other very common symptoms are lack of energy, memory problems, depression, problems with concentration, and problems sleeping. Other manifestations of hyperparathyroidism usually involve the kidney (stones) and the skeletal system (bone pain due to the development of osteoporosis). Clinical depression (also called major depressive disorder, or sometimes unipolar when compared with bipolar disorder, which is sometimes called manic depression) is a state of intense sadness, melancholia or despair that has advanced to the point of being disruptive to an individuals social functioning and/or activities of daily... Definition A sleep disorder is a disorder in the sleep patterns of a person or animal. ... Kidney stones are solid accretions (crystals) of dissolved minerals in urine found inside the kidneys or ureters. ... Osteoporosis is a disease of bone in which the bone mineral density (BMD) is reduced, bone microarchitecture is disrupted, and the amount and variety of non-collagenous proteins in bone is altered. ...


The symptoms of hyperparathyroidism can be classically remembered by the rhyme "moans" (complaints of not feeling well), "groans" (abdominal pain, GERD), "stones" (kidney), "bones" (bone pain), and "psychiatric overtones" (lethargy, fatigue, depression, memory problems).


Almost all patients with hyperparathyroidism will develop osteoporosis. If untreated, this osteoporosis can be extreme. Unfortunately, medicines are usually not useful for treating the osteoporosis associated with hyperparathyroidism until the parathyroid tumor is removed. Osteoporosis associated with hyperparathyroidism is caused by the high parathyroid hormone that is secreted by the overactive parathyroid gland(s). This excess parathyroid hormone (PTH) acts directly on the bones to remove calcium from the bones. Thus, the high calcium in the blood comes from the bones. Removing the offending parathyroid gland will usually cause a significant improvement in the osteoporosis, often reversing this process back to normal bone density over several years.


Other symptoms include: headaches, gastroesophageal reflux, decreased sex drive, thinning hair, hypertension, and heart palpitations which are often due to bouts of atrial fibrilation. A headache is a condition of pain in the head; sometimes neck or upper back pain may also be interpreted as a headache. ... Gastroesophageal Reflux Disease (GERD; or GORD when spelling Å“sophageal, the BrE form) is defined as chronic symptoms or mucosal damage produced by the abnormal reflux of gastric contents into the esophagus[1]. This is commonly due to transient or permanent changes in the barrier between the esophagus and the stomach. ... Arterial hypertension, or high blood pressure is a medical condition where the blood pressure is chronically elevated. ...


Almost all patients will have symptoms if their calcium is high and the right questions are asked. Removing the parathyroid tumor which is causing the excess parathyroid hormone will eliminate the symptoms in most patients within several days or weeks. Often it is life-changing when the parathyroid tumor is removed.


Diagnosis

The gold standard of diagnosis is the PTH immunoassay. Once an elevated PTH has been confirmed, goal of diagnosis is to determine whether the hyperparathyroidism is primary or secondary in origin by obtaining a serum calcium level: General Name, Symbol, Number calcium, Ca, 20 Chemical series alkaline earth metals Group, Period, Block 2, 4, s Appearance silvery white Standard atomic weight 40. ...

PTH serum calcium likely type
high high primary hyperparathyroidism
high low or normal secondary hyperparathyroidism

Tertiary hyperparathyroidism has a high PTH and a high serum calcium. It is differentiated from primary hyperparathyroidism by a history of chronic kidney failure and secondary hyperparathyroidism. General Name, Symbol, Number calcium, Ca, 20 Chemical series alkaline earth metals Group, Period, Block 2, 4, s Appearance silvery white Standard atomic weight 40. ... Primary hyperparathyroidism causes hypercalcemia (elevated blood calcium levels) through the excessive secretion of parathyroid hormone (PTH), usually by an adenoma (benign tumors) of the parathyroid glands. ... Secondary hyperparathyroidism refers to the excessive secretion of parathyroid hormone (PTH) by the parathyroid glands in response to hypocalcemia (low blood calcium levels) and associated hypertrophy of the glands. ... Tertiary hyperparathyroidism is a state of excessive secretion of parathyroid hormone (PTH) after a long period of secondary hyperparathyroidism and resulting in hypercalcemia. ... Chronic renal failure (CRF, or chronic kidney failure, CKF, or chronic kidney disease, CKD) is a slowly progressive loss of renal function over a period of months or years and defined as an abnormally low glomerular filtration rate, which is usually determined indirectly by the creatinine level in blood serum. ...


Treatment

Treatment is first and foremost directed at hypercalcemia, if symptomatic patients are sent for surgery to remove the parathyroid tumor (parathyroid adenoma). (see hypercalcemia) Most experts now believe that almost all patients with hyperparathyroidism should be evaluated for surgery. Watching and waiting has been falling out of vogue since it is being realized that the disease will rarely stay the same. It will almost always progress as the tumor grows. Hypercalcaemia is an elevated calcium level in the blood. ...

Primary hyperparathyroidism causes hypercalcemia (elevated blood calcium levels) through the excessive secretion of parathyroid hormone (PTH), usually by an adenoma (benign tumors) of the parathyroid glands. ... Secondary hyperparathyroidism refers to the excessive secretion of parathyroid hormone (PTH) by the parathyroid glands in response to hypocalcemia (low blood calcium levels) and associated hypertrophy of the glands. ...

See also

In medicine (endocrinology), hypoparathyroidism is decreased function of the parathyroid glands, leading to decreased levels of parathyroid hormone (PTH). ... Multiple endocrine neoplasia (MEN) (or multiple endocrine adenomas, or multiple endocrine adenomatosis -- MEA) consists of three syndromes featuring tumors of endocrine glands, each with its own characteristic pattern. ...

External links


  Results from FactBites:
 
New York Thyroid Center: Hyperparathyroidism (707 words)
Most cases (85%) of hyperparathyroidism are the result of a single parathyroid gland malfunctioning and developing into a benign tumor, known as an adenoma.
Oftentimes a person with hyperparathyroidism has no symptoms, or they attribute their symptoms to other causes, and they first learn about the disease from blood tests taken during a routine visit to the doctor.
Hyperparathyroidism is diagnosed by simple blood tests which check the blood level of calcium as well as a blood level of parathyroid hormone.
MDchoice.com The Ultimate Medical Information Finder Primary Hyperparathyroidism Disorder (1222 words)
Primary hyperparathyroidism is a disorder of the parathyroid glands.
Hyperparathyroidism is diagnosed when tests show that blood levels of calcium as well as parathyroid hormone are too high.
Surgery for hyperparathyroidism is highly successful with a low complication rate when performed by surgeons experienced with this condition.
  More results at FactBites »

 
 

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