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__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
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|Hyperfunction of parathyroid cells due to hyperplasia, adenoma or carcinoma.
|
|Physiological stimulation of parathyroid in response to hypocalcaemia.
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|Following long term physiological stimulation leading to hyperplasia.
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|-
|-
|Cause
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|
|
|
|
|
|
|-
|-
|Associations
|
|May be associated with multiple endocrine neoplasia.
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|Usually due to chronic renal failure or other causes of Vitamin D deficiency.
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|Seen in chronic renal failure.
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|-
|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.
|}
|}
=Epidemiology PE & DVT=
===Incidence===
The incidence of VTE increases with age, ranging from less than 5 cases per 100,000 people in childhood to 500 cases per 100,000 people in the elderly.<ref name="pmid12814979">{{cite journal |author=White RH |title=The epidemiology of venous thromboembolism |journal=Circulation |volume=107 |issue=23 Suppl 1 |pages=I4–8 |year=2003 |month=June |pmid=12814979 |doi=10.1161/01.CIR.0000078468.11849.66 |url=}}</ref> Subjects who are more than 65 years of age are at three times higher risk for VTE compared to those who are 45-54 years old.<ref name="pmid15210384">{{cite journal| author=Cushman M, Tsai AW, White RH, Heckbert SR, Rosamond WD, Enright P et al.| title=Deep vein thrombosis and pulmonary embolism in two cohorts: the longitudinal investigation of thromboembolism etiology. | journal=Am J Med | year= 2004 | volume= 117 | issue= 1 | pages= 19-25 | pmid=15210384 | doi=10.1016/j.amjmed.2004.01.018 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15210384  }} </ref>
===Age===
The incidence of VTE increases with age, ranging from less than 5 cases per 100,000 people in childhood to 500 cases per 100,000 people in the elderly.<ref name="pmid12814979">{{cite journal |author=White RH |title=The epidemiology of venous thromboembolism |journal=Circulation |volume=107 |issue=23 Suppl 1 |pages=I4–8 |year=2003 |month=June |pmid=12814979 |doi=10.1161/01.CIR.0000078468.11849.66 |url=}}</ref> Subjects who are more than 65 years of age are at three times higher risk for VTE compared to those who are 45-54 years old.<ref name="pmid15210384">{{cite journal| author=Cushman M, Tsai AW, White RH, Heckbert SR, Rosamond WD, Enright P et al.| title=Deep vein thrombosis and pulmonary embolism in two cohorts: the longitudinal investigation of thromboembolism etiology. | journal=Am J Med | year= 2004 | volume= 117 | issue= 1 | pages= 19-25 | pmid=15210384 | doi=10.1016/j.amjmed.2004.01.018 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15210384  }} </ref>
===Gender===
Studies about differences in the incidence of VTE by gender have mixed results.
*Some reported a higher incidence of DVT among young females<ref name="pmid9521222">{{cite journal |author=Silverstein MD, Heit JA, Mohr DN, Petterson TM, O'Fallon WM, Melton LJ |title=Trends in the incidence of deep vein thrombosis and pulmonary embolism: a 25-year population-based study |journal=Arch. Intern. Med. |volume=158 |issue=6 |pages=585–93 |year=1998 |month=March |pmid=9521222 |doi= |url=}}</ref>
*Some reported it higher among either older females<ref name="pmid8154949">{{cite journal |author=Kniffin WD, Baron JA, Barrett J, Birkmeyer JD, Anderson FA |title=The epidemiology of diagnosed pulmonary embolism and deep venous thrombosis in the elderly |journal=Arch. Intern. Med. |volume=154 |issue=8 |pages=861–6 |year=1994 |month=April |pmid=8154949 |doi= |url=}}</ref>
*Some reported it higher in men.<ref name="pmid15210384">{{cite journal |author=Cushman M, Tsai AW, White RH, ''et al.'' |title=Deep vein thrombosis and pulmonary embolism in two cohorts: the longitudinal investigation of thromboembolism etiology |journal=Am. J. Med. |volume=117 |issue=1 |pages=19–25 |year=2004 |month=July |pmid=15210384 |doi=10.1016/j.amjmed.2004.01.018 |url=}}</ref><ref name="urlVenous Thromboembolism in Adult Hospitalizations — United States, 2007–2009">{{cite web |url=http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6122a1.htm?s_cid=mm6122a1_w |title=Venous Thromboembolism in Adult Hospitalizations — United States, 2007–2009 |format= |work= |accessdate=2012-10-06}}</ref>  In addition, the risk for DVT was reported to consistently increase with age across both genders.<ref name="pmid15210384">{{cite journal |author=Cushman M, Tsai AW, White RH, ''et al.'' |title=Deep vein thrombosis and pulmonary embolism in two cohorts: the longitudinal investigation of thromboembolism etiology |journal=Am. J. Med. |volume=117 |issue=1 |pages=19–25 |year=2004 |month=July |pmid=15210384 |doi=10.1016/j.amjmed.2004.01.018 |url=}}</ref>
===Race===
* There is a significant difference in the incidence of DVT as it relates to race.  African Americans characteristically have the highest incidence of DVT while Caucasians rank as the second highest incidence of DVT.<ref name="pmid12814979">{{cite journal| author=White RH| title=The epidemiology of venous thromboembolism. | journal=Circulation | year= 2003 | volume= 107 | issue= 23 Suppl 1 | pages= I4-8 | pmid=12814979 | doi=10.1161/01.CIR.0000078468.11849.66 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12814979  }} </ref>
* When compared to African Americans and Caucasians, the incidence of DVT is noted to be two to four times lower in Hispanics and Asian-Pacific Islanders.<ref name="pmid12814979">{{cite journal| author=White RH| title=The epidemiology of venous thromboembolism. | journal=Circulation | year= 2003 | volume= 107 | issue= 23 Suppl 1 | pages= I4-8 | pmid=12814979 | doi=10.1161/01.CIR.0000078468.11849.66 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12814979  }} </ref>
* Lower thrombosis incidences in non-Caucasians may be related to a lower prevalence of disorders like [[Factor V Leiden]] or [[Thrombin#Prothrombin 20210a mutation|Prothrombin 20210A mutation]].<ref name="pmid9109469">{{cite journal| author=Ridker PM, Miletich JP, Hennekens CH, Buring JE| title=Ethnic distribution of factor V Leiden in 4047 men and women. Implications for venous thromboembolism screening. | journal=JAMA | year= 1997 | volume= 277 | issue= 16 | pages= 1305-7 | pmid=9109469 | doi= | pmc= | url= }} </ref><ref name="pmid9415695">{{cite journal| author=Gregg JP, Yamane AJ, Grody WW| title=Prevalence of the factor V-Leiden mutation in four distinct American ethnic populations. | journal=Am J Med Genet | year= 1997 | volume= 73 | issue= 3 | pages= 334-6 | pmid=9415695 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9415695  }} </ref>
===Hospitalization for VTE===
* During 2007–2009, an estimated annual average of 547,596 hospitalizations had a diagnosis of VTE for adults aged ≥18 years. Estimates for DVT and PE diagnoses were not mutually exclusive. An estimated annual average of 348,558 adult hospitalizations had a diagnosis of DVT, and 277,549 adult hospitalizations had a diagnosis of PE. An estimated annual average of 78,511 adult hospitalizations (14% of overall VTE hospitalizations) had diagnoses of both DVT and PE.<ref name=CDC2> [http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6122a1.htm?s_cid=mm6122a1_w ] Hussain R. Yusuf, MD, James Tsai, MD, Hani K. Atrash, MD, Sheree Boulet, DrPH, Scott D. Grosse, PhD, Div of Blood Disorders, National Center on Birth Defects and Developmental Disabilities, CDC. Venous Thromboembolism in Adult Hospitalizations — United States, 2007–2009</ref>
* The estimated average annual number of hospitalizations with VTE was successively greater among older age groups: 54,034 for persons aged 18–39 years; 143,354 for persons aged 40–59 years; and 350,208 for persons aged ≥60 years. The estimated average annual number of hospitalizations with VTE was comparable for men (250,973) and women (296,623).<ref name=CDC2> [http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6122a1.htm?s_cid=mm6122a1_w ] Hussain R. Yusuf, MD, James Tsai, MD, Hani K. Atrash, MD, Sheree Boulet, DrPH, Scott D. Grosse, PhD, Div of Blood Disorders, National Center on Birth Defects and Developmental Disabilities, CDC. Venous Thromboembolism in Adult Hospitalizations — United States, 2007–2009</ref>  Shown below is an image depicting the estimated average annual number of hospitalization with a diagnosis of DVT, PE, or VTE by age and sex (image courtesy of CDC.gov<ref name=CDC2> [http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6122a1.htm?s_cid=mm6122a1_w ] Hussain R. Yusuf, MD, James Tsai, MD, Hani K. Atrash, MD, Sheree Boulet, DrPH, Scott D. Grosse, PhD, Div of Blood Disorders, National Center on Birth Defects and Developmental Disabilities, CDC. Venous Thromboembolism in Adult Hospitalizations — United States, 2007–2009</ref>).
[[File:Estimated average annual number of hospitalization VTE.gif]]
* The average annual rates of hospitalizations with a discharge diagnosis of DVT, PE, or VTE among adults were 152, 121, and 239 per 100,000 population, respectively. For VTE, the average annual rates were 60 per 100,000 population aged 18–39 years, 143 for persons aged 40–49 years, 200 for persons aged 50–59 years, 391 for persons aged 60–69 years, 727 for persons aged 70–79 years, and 1,134 for persons aged ≥80 years. The rates of hospitalization were similar for men and women, and the point estimates increased for both sexes by age.<ref name=CDC2> [http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6122a1.htm?s_cid=mm6122a1_w ] Hussain R. Yusuf, MD, James Tsai, MD, Hani K. Atrash, MD, Sheree Boulet, DrPH, Scott D. Grosse, PhD, Div of Blood Disorders, National Center on Birth Defects and Developmental Disabilities, CDC. Venous Thromboembolism in Adult Hospitalizations — United States, 2007–2009</ref>
* On average, 28,726 hospitalized adults with a VTE diagnosis died each year. Of these patients, an average of 13,164 had a DVT diagnosis and 19,297 had a PE diagnosis; 3,735 had both DVT and PE diagnoses.<ref name=CDC2> [http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6122a1.htm?s_cid=mm6122a1_w ] Hussain R. Yusuf, MD, James Tsai, MD, Hani K. Atrash, MD, Sheree Boulet, DrPH, Scott D. Grosse, PhD, Div of Blood Disorders, National Center on Birth Defects and Developmental Disabilities, CDC. Venous Thromboembolism in Adult Hospitalizations — United States, 2007–2009</ref>
===Recurrence of VTE===
* One-third (about 33%) of people with VTE will have a recurrence within 10 years.<ref name=CDC3>[http://www.cdc.gov/ncbddd/dvt/data.html CDC- Deep Vein Thrombosis (DVT) / Pulmonary Embolism (PE) — Blood Clot Forming in a Vein]</ref><ref name="pmid20331949">{{cite journal| author=Beckman MG, Hooper WC, Critchley SE, Ortel TL| title=Venous thromboembolism: a public health concern. | journal=Am J Prev Med | year= 2010 | volume= 38 | issue= 4 Suppl | pages= S495-501 | pmid=20331949 | doi=10.1016/j.amepre.2009.12.017 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20331949  }} </ref>
* The risk of recurrence of [[VTE]] in patients diagnosed with first-time [[VTE]] is estimated to be around 7-8 percent per year during an average follow up period of 2.2 years of subsequent observation of 265 patients.<ref name="pmid15210384">{{cite journal |author=Cushman M, Tsai AW, White RH, ''et al.''|title=Deep vein thrombosis and pulmonary embolism in two cohorts: the longitudinal investigation of thromboembolism etiology |journal=Am. J. Med.|volume=117 |issue=1 |pages=19–25 |year=2004 |month=July |pmid=15210384 |doi=10.1016/j.amjmed.2004.01.018 |url=}}</ref>
* Among patients with a first episode of VTE, the risk of recurrence of VTE is particularly elevated in the first 6 to 12 months following the first episode of VTE.  The risk of recurrent VTE remains up to 10 years, with a estimated cumulative incidence of first overall VTE recurrence of 30 %.  Predictors for recurrence of [[VTE]] include [[malignancy]], neurological diseases, and [[paresis]].<ref name="pmid10737275">{{cite journal |author=Heit JA, Mohr DN, Silverstein MD, Petterson TM, O'Fallon WM, Melton LJ |title=Predictors of recurrence after deep vein thrombosis and pulmonary embolism: a population-based cohort study |journal=Arch. Intern. Med. |volume=160 |issue=6 |pages=761–8 |year=2000 |month=March |pmid=10737275 |doi= |url=}}</ref>
* In recent years, the increase in [[thrombosis]] incidence may be related to improved diagnostic modalities and increased awareness by clinicians.<ref name="pmid12814979">{{cite journal |author=White RH |title=The epidemiology of venous thromboembolism |journal=Circulation |volume=107 |issue=23 Suppl 1 |pages=I4–8 |year=2003|month=June |pmid=12814979 |doi=10.1161/01.CIR.0000078468.11849.66 |url=}}</ref>
===Complications of VTE===
* Estimates suggest that 60,000-100,000 Americans die of VTE, 10 to 30% of which will die within one month of diagnosis.<ref name="pmid20331949">{{cite journal| author=Beckman MG, Hooper WC, Critchley SE, Ortel TL| title=Venous thromboembolism: a public health concern. | journal=Am J Prev Med | year= 2010 | volume= 38 | issue= 4 Suppl | pages= S495-501 | pmid=20331949 | doi=10.1016/j.amepre.2009.12.017 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20331949  }} </ref><ref name=CDC3>[http://www.cdc.gov/ncbddd/dvt/data.html CDC- Deep Vein Thrombosis (DVT) / Pulmonary Embolism (PE) — Blood Clot Forming in a Vein]</ref>
* Among people who have had a DVT, one-half will have long-term complications ([[post-thrombotic syndrome]]) such as swelling, pain, discoloration, and scaling in the affected limb.<ref name="pmid20331949">{{cite journal| author=Beckman MG, Hooper WC, Critchley SE, Ortel TL| title=Venous thromboembolism: a public health concern. | journal=Am J Prev Med | year= 2010 | volume= 38 | issue= 4 Suppl | pages= S495-501 | pmid=20331949 | doi=10.1016/j.amepre.2009.12.017 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20331949  }} </ref><ref name=CDC3>[http://www.cdc.gov/ncbddd/dvt/data.html CDC- Deep Vein Thrombosis (DVT) / Pulmonary Embolism (PE) — Blood Clot Forming in a Vein]</ref>


==References==
==References==
{{reflist|2}}
{{reflist|2}}

Latest revision as of 17:32, 14 January 2019


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Anmol Pitliya, M.B.B.S. M.D.[2]

Tables

Diagnosis Lab findings

References

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