فرط نشاط الغدة جار الدرقية

Definition

Hyperparathyroidism is excess PTH, drawing calcium from bone and raising serum calcium.

Types

• Primary: usually a single benign adenoma
• Secondary: a response to low calcium in kidney failure or vitamin D deficiency

Symptoms (stones, bones, abdominal groans, psychic moans)

• Kidney stones, polyuria and thirst
• Bone pain, osteoporosis and fractures
• Constipation, nausea, ulcers and pancreatitis
• Fatigue, depression and poor concentration
• Many cases are found incidentally

Diagnosis

High calcium with high or inappropriately normal PTH, bone density and imaging to localise the gland.

Treatment

• Surgery to remove the overactive gland in most symptomatic cases
• Adequate hydration and avoiding thiazides
• Severe hypercalcaemia: IV fluids then bisphosphonates

After surgery

Watch for hypocalcaemia (tingling, spasm, Trousseau sign), voice changes and bleeding.

Exam point

Severe post-operative hypocalcaemia can occur as bone takes up calcium (hungry bone syndrome).