|
|
| (151 intermediate revisions by 3 users not shown) |
| Line 1: |
Line 1: |
| __NOTOC____NOTOC__
| | __NOTOC__ |
| {{Hyperparathyroidism}}
| |
|
| |
|
| {{CMG}}; {{AE}} {{Anmol}} | | {{CMG}}; {{AE}} {{Anmol}} |
|
| |
|
| == 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 | | | |
| | | | | |
| | | | | |
| | | | | |
| |- | | |- |
| |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. | | | |
| |-
| |
| |Serum calcium
| |
| |High
| |
| |Low/Normal
| |
| |High
| |
| |-
| |
| |Serum phosphate
| |
| |Low/Normal
| |
| |High
| |
| |High
| |
| |-
| |
| |Management
| |
| |Usually surgery if symptomatic. Cincacalcet can be considered in those not fit for surgery.
| |
| |Treatment of underlying cause.
| |
| |Usually cinacalcet or surgery in those that don't respond.
| |
| |} | | |} |
|
| |
| =Causes=
| |
| ===Common Causes===
| |
| *Post-surgical (most common cause)<ref name="pmid11117980">{{cite journal |vauthors=Marx SJ |title=Hyperparathyroid and hypoparathyroid disorders |journal=N. Engl. J. Med. |volume=343 |issue=25 |pages=1863–75 |year=2000 |pmid=11117980 |doi=10.1056/NEJM200012213432508 |url=}}</ref>
| |
| **[[Thyroidectomy]]
| |
| **[[Parathyroidectomy]]
| |
| **Radical neck dissection
| |
| *Autoimmune (2nd most common cause)<ref name="pmid15141045">{{cite journal |vauthors=Eisenbarth GS, Gottlieb PA |title=Autoimmune polyendocrine syndromes |journal=N. Engl. J. Med. |volume=350 |issue=20 |pages=2068–79 |year=2004 |pmid=15141045 |doi=10.1056/NEJMra030158 |url=}}</ref>
| |
| **Polyglandular autoimmune syndrome type 1
| |
| **Isolated autoimmune hypoparathyroidism
| |
|
| |
| ===Less Common Causes===
| |
| *Infiltration and/or destruction of parathyroid glands
| |
| **Metal overload
| |
| ***Iron overload
| |
| ****Hemochromatosis
| |
| ****Thalassemia ( due to repeated blood transfusion)
| |
| ***Copper overload
| |
| ****Wilson's disease
| |
| ***Aluminium deposition
| |
| ****Usually seen in patients with end-stage renal disease on hemodialysis
| |
| ***Hypermagnesemia
| |
| **Radiation-induced destruction parathyroid glands
| |
| **Hypomagnesemia (reversible)
| |
| **Metastatic disease
| |
| **Granulomatous disease
| |
| ***Amyloidosis
| |
| **Syphilis
| |
| *Progressive systemic sclerosis
| |
| *Neonatal cause
| |
| **Maternal hyperparathyroidism
| |
| *Genetic causes
| |
|
| |
| ===Genetic Causes===
| |
| *Isolated primary hypoparathyroidism
| |
| *X-linked primary hypoparathyroidism (band Xq26-Xq27)
| |
| *X autosomal-recessive primary hypoparathyroidism
| |
| *Branchial dysgenesis (DiGeorge syndrome)
| |
| *Chromosomal defects dup(1q),del(5p),dup(8q),del(10q),del(22q)
| |
| *Monogenic hypoparathyroidism
| |
| *Velocardiofacial (Shprintzen) syndrome (CATCH 22 [for cardiac, abnormal facies, thymic aplasia, cleft palate, and hypocalcemia with 22q deletion] is a mnemonic for the features of this syndrome.)
| |
| *Zellweger syndrome
| |
| *Diabetic embryopathy
| |
| *Fetal alcohol syndrome
| |
| *Retinoid embryopathy
| |
| *Associational arhinencephalia and/or DiGeorge syndrome and the coloboma, heart disease, choanal atresia, retarded growth and development, genital anomalies, ear anomalies (CHARGE) syndrome and/or DiGeorge syndrome
| |
| *Cardiofacial–DiGeorge–Kenny-Caffey syndrome (ie, absent parathyroid tissue, growth retardation, medullary stenosis of tubular bones)
| |
| *Kearns-Sayre syndrome (ie, mitochondrial myopathy, ophthalmoplegia, retinal degeneration, cardiac conduction defects, primary hypoparathyroidism)
| |
| *Barakat syndrome (ie, primary hypoparathyroidism, nerve deafness, steroid-resistant nephrosis)
| |
| *Hypoparathyroidism with short stature, mental retardation, and seizures
| |
| *Familial isolated hypoparathyroidism
| |
| *Sanjad-Sakati syndrome (hypoparathyroidism – intellectual disability – dysmorphism)
| |
|
| |
|
| ==References== | | ==References== |
| | {{reflist|2}} |