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| __NOTOC__ | | __NOTOC__ |
| {{Hyperparathyroidism}}
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| {{CMG}}; {{AE}} {{Anmol}} | | {{CMG}}; {{AE}} {{Anmol}} |
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| == Classification == | | ==Tables== |
| {| class="wikitable" | | {| class="wikitable" |
| ! colspan="4" |Classification of hyperparathyridism | | |+ |
| | !Diagnosis |
| | !Lab findings |
| | ! |
| | ! |
| |- | | |- |
| |Features
| | ! |
| |'''Primary hyperparathyroidism'''
| | ! |
| |'''Secondary hyperparathyroidism'''
| | ! |
| |'''Tertiary hyperparathyroidism'''
| | ! |
| |- | | |- |
| |Pathology | | | |
| |Hyperfunction of parathyroid cells due to hyperplasia, adenoma or carcinoma. | | | |
| |Physiological stimulation of parathyroid in response to hypocalcaemia. | | | |
| |Following long term physiological stimulation leading to hyperplasia. | | | |
| |- | | |- |
| |Cause | | | |
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| |- | | |- |
| |Associations | | | |
| |May be associated with multiple endocrine neoplasia. | | | |
| |Usually due to chronic renal failure or other causes of Vitamin D deficiency. | | | |
| |Seen in chronic renal failure. | | | |
| |-
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| |Serum calcium
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| |High
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| |Low/Normal
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| |High
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| |-
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| |Serum phosphate
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| |Low/Normal
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| |High
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| |High
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| |-
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| |Management
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| |Usually surgery if symptomatic. Cincacalcet can be considered in those not fit for surgery.
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| |Treatment of underlying cause.
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| |Usually cinacalcet or surgery in those that don't respond.
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| |} | | |} |
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| =Causes=
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| ==Overview==
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| Hyperparathyroidism is caused by an increase in concentration of parathyroid hormone in serum.
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| There are three type of hyperparathyroidism including primary, secondary and tertiary hyperparathyroidism.
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| The causes of all hyperparathyroidism is different.
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| ==Causes of Primary hyperparathyroidism==
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| Causes of primary hyperparathyroidism are as follows:
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| ===Common causes===
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| *Parathyroid adenoma
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| **Usually single gland affected
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| **Sometimes multiple gland affected
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| ===Less common causes===
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| *Parathyroid hyperplasia
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| *Parathyroid carcinoma
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| *Familial isloated hyperparathyroidism
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| *Radiation exposure (due to development of parathyroid adenoma or parathyroid hyperplasia)<ref name="pmid21848480">{{cite journal| author=Boehm BO, Rosinger S, Belyi D, Dietrich JW| title=The parathyroid as a target for radiation damage. | journal=N Engl J Med | year= 2011 | volume= 365 | issue= 7 | pages= 676-8 | pmid=21848480 | doi=10.1056/NEJMc1104982 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21848480 }} </ref><ref name="pmid18774659">{{cite journal| author=McMullen T, Bodie G, Gill A, Ihre-Lundgren C, Shun A, Bergin M et al.| title=Hyperparathyroidism after irradiation for childhood malignancy. | journal=Int J Radiat Oncol Biol Phys | year= 2009 | volume= 73 | issue= 4 | pages= 1164-8 | pmid=18774659 | doi=10.1016/j.ijrobp.2008.06.1487 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18774659 }} </ref><ref name="pmid890665">{{cite journal| author=Tisell LE, Hansson G, Lindberg S, Ragnhult I| title=Hyperparathyroidism in persons treated with X-rays for tuberculous cervical adenitis. | journal=Cancer | year= 1977 | volume= 40 | issue= 2 | pages= 846-54 | pmid=890665 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=890665 }} </ref>
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| *Celiac disease<ref name="pmid17148709">{{cite journal |vauthors=Maida MJ, Praveen E, Crimmins SR, Swift GL |title=Coeliac disease and primary hyperparathyroidism: an association? |journal=Postgrad Med J |volume=82 |issue=974 |pages=833–5 |year=2006 |pmid=17148709 |pmc=2653933 |doi=10.1136/pgmj.2006.045500 |url=}}</ref><ref name="pmid22238405">{{cite journal |vauthors=Ludvigsson JF, Kämpe O, Lebwohl B, Green PH, Silverberg SJ, Ekbom A |title=Primary hyperparathyroidism and celiac disease: a population-based cohort study |journal=J. Clin. Endocrinol. Metab. |volume=97 |issue=3 |pages=897–904 |year=2012 |pmid=22238405 |pmc=3319223 |doi=10.1210/jc.2011-2639 |url=}}</ref>
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| ===Genetic causes===
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| *HRPT2 gene mutations:<ref name="pmid14585940">{{cite journal| author=Shattuck TM, Välimäki S, Obara T, Gaz RD, Clark OH, Shoback D et al.| title=Somatic and germ-line mutations of the HRPT2 gene in sporadic parathyroid carcinoma. | journal=N Engl J Med | year= 2003 | volume= 349 | issue= 18 | pages= 1722-9 | pmid=14585940 | doi=10.1056/NEJMoa031237 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14585940 }} </ref>
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| **HRPT2 gene code for parafibromin protein.
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| **HRPT2 gene mutations are found in a type of familial hyperparathyroidism, hyperparathyroidism-jaw tumor (HPT-JT) syndrome.
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| **HRTP2 gene mutations increases risk of parathyroid carcinoma.
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| *Cyclin D1 gene (CCND1)/PRAD1 gene:<ref name="pmid19373510">{{cite journal| author=Westin G, Björklund P, Akerström G| title=Molecular genetics of parathyroid disease. | journal=World J Surg | year= 2009 | volume= 33 | issue= 11 | pages= 2224-33 | pmid=19373510 | doi=10.1007/s00268-009-0022-6 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19373510 }} </ref><ref name="pmid8626826">{{cite journal| author=Hsi ED, Zukerberg LR, Yang WI, Arnold A| title=Cyclin D1/PRAD1 expression in parathyroid adenomas: an immunohistochemical study. | journal=J Clin Endocrinol Metab | year= 1996 | volume= 81 | issue= 5 | pages= 1736-9 | pmid=8626826 | doi=10.1210/jcem.81.5.8626826 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8626826 }} </ref>
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| **PRAD1 (parathyroid adenoma 1) is a protooncogene located on chromosome 11q13.
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| **Cyclin D1 gene translocation and oncogene action observerd in 8% of adenomas
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| **Cyclin D1 gene overexpression is pbserved in 20% to 40% of parathyroid adenomas
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| *MEN1 gene:<ref name="pmid19373510">{{cite journal| author=Westin G, Björklund P, Akerström G| title=Molecular genetics of parathyroid disease. | journal=World J Surg | year= 2009 | volume= 33 | issue= 11 | pages= 2224-33 | pmid=19373510 | doi=10.1007/s00268-009-0022-6 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19373510 }} </ref><ref name="pmid9215689">{{cite journal| author=Agarwal SK, Kester MB, Debelenko LV, Heppner C, Emmert-Buck MR, Skarulis MC et al.| title=Germline mutations of the MEN1 gene in familial multiple endocrine neoplasia type 1 and related states. | journal=Hum Mol Genet | year= 1997 | volume= 6 | issue= 7 | pages= 1169-75 | pmid=9215689 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9215689 }} </ref>
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| **MEN1 is a tumor supressor gene on chronosome 11q13.
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| **Somatic loss of single MEN1 allele is observed in 25% to 40% of sporadic parathyroid adenomas.
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| ==Causes of secondary hyperparathyroidism==
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| Causes of secondary hyperparathyroidism are as follows:
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| ===Common causes===
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| *Chronic renal failure (leading to parathyroid hyperplasia)<ref name="pmid15507543">{{cite journal| author=Rodriguez M, Nemeth E, Martin D| title=The calcium-sensing receptor: a key factor in the pathogenesis of secondary hyperparathyroidism. | journal=Am J Physiol Renal Physiol | year= 2005 | volume= 288 | issue= 2 | pages= F253-64 | pmid=15507543 | doi=10.1152/ajprenal.00302.2004 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15507543 }} </ref>
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| *Vitamin D deficiency<ref name="pmid11493580">{{cite journal| author=Lips P| title=Vitamin D deficiency and secondary hyperparathyroidism in the elderly: consequences for bone loss and fractures and therapeutic implications. | journal=Endocr Rev | year= 2001 | volume= 22 | issue= 4 | pages= 477-501 | pmid=11493580 | doi=10.1210/edrv.22.4.0437 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11493580 }} </ref>
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| ===Less common causes===
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| *Severe calcium deficiency<ref name="pmid16512945">{{cite journal| author=Mehrotra M, Gupta SK, Kumar K, Awasthi PK, Dubey M, Pandey CM et al.| title=Calcium deficiency-induced secondary hyperparathyroidism and osteopenia are rapidly reversible with calcium supplementation in growing rabbit pups. | journal=Br J Nutr | year= 2006 | volume= 95 | issue= 3 | pages= 582-90 | pmid=16512945 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16512945 }} </ref>
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| *Gastric bypass surgery, particularly roux-en-Y gastric bypass (RYGBP)<ref name="pmid16633006">{{cite journal |vauthors=Johnson JM, Maher JW, DeMaria EJ, Downs RW, Wolfe LG, Kellum JM |title=The long-term effects of gastric bypass on vitamin D metabolism |journal=Ann. Surg. |volume=243 |issue=5 |pages=701–4; discussion 704–5 |year=2006 |pmid=16633006 |pmc=1570540 |doi=10.1097/01.sla.0000216773.47825.c1 |url=}}</ref>
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| *Malabsorption syndrome<ref name="pmid19836494">{{cite journal |vauthors=Pitt SC, Sippel RS, Chen H |title=Secondary and tertiary hyperparathyroidism, state of the art surgical management |journal=Surg. Clin. North Am. |volume=89 |issue=5 |pages=1227–39 |year=2009 |pmid=19836494 |pmc=2905047 |doi=10.1016/j.suc.2009.06.011 |url=}}</ref>
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| ==Causes of tertiary hyperparathyroidism==
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| Causes of tertiary hyperparathyroidism are as follows:
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| ===Common causes===
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| *Chronic renal failure (leading to parathyroid hyperplasia)
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| *Renal transplant patients<ref name="pmid9780988">{{cite journal |vauthors=Kilgo MS, Pirsch JD, Warner TF, Starling JR |title=Tertiary hyperparathyroidism after renal transplantation: surgical strategy |journal=Surgery |volume=124 |issue=4 |pages=677–83; discussion 683–4 |year=1998 |pmid=9780988 |doi=10.1067/msy.1998.91483 |url=}}</ref>
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| ===Less common cause===
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| *Long standing celiac disease<ref name="pmid17148709">{{cite journal |vauthors=Maida MJ, Praveen E, Crimmins SR, Swift GL |title=Coeliac disease and primary hyperparathyroidism: an association? |journal=Postgrad Med J |volume=82 |issue=974 |pages=833–5 |year=2006 |pmid=17148709 |pmc=2653933 |doi=10.1136/pgmj.2006.045500 |url=}}</ref>
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| =Pathogenesis=
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| ==Associated conditiond==
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| Pancreatitis<ref name="pmid22874807">{{cite journal |vauthors=Bai HX, Giefer M, Patel M, Orabi AI, Husain SZ |title=The association of primary hyperparathyroidism with pancreatitis |journal=J. Clin. Gastroenterol. |volume=46 |issue=8 |pages=656–61 |year=2012 |pmid=22874807 |pmc=4428665 |doi=10.1097/MCG.0b013e31825c446c |url=}}</ref>
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| ==References== | | ==References== |
| | {{reflist|2}} |