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Hyperparathyroidism

Tumor biology and incidence

  • Characterized by elevated serum PTH, hypercalcemia and hypophosphatemia
  • Classified as primary, secondary or tertiary.
    • Primary: Caused by parathyroid adenoma (approximately 80% of cases), multiple adenomas, hyperplasia or carcinoma of parathyroid tissues
    • Secondary: Usually result of renal or intestinal losses of calcium
    • Tertiary: Occurs when secondary hyperparathyroidism becomes autonomous

Presentation and physical findings

  • Signs and symptoms: "Stones , bones, gastrointestinal groans, psychiatric moans, and fatigue overtones"
    • Stones: Nephrolithiasis and nephrocalcinosis
    • Bones: Often painful, tender, weak, and susceptible to pathologic fracture
    • Patient may develop generalized osteitis fibrosa cystica (fibrous replacement of the marrow) or may develop a brown tumor
    • Gastrointestinal: Abdominal pain possibly due to peptic ulcer or pancreatitis
    • Psychiatric: May develop depression, psychosis
    • Fatigue: Weakness or hypotonia of the muscles
  • Elevated serum calcium, elevated serum PTH, and decreased serum phosphate

Radiographic appearance

  • Early, generalized osteopenia; often overlooked
    • Changes related to increased osteoclast activity, decreased thickness of trabeculae
    • Best seen in X-rays of hands, spine
    • May see soft tissue calcification, vascular calcifications
  • Moderate osteopenia: Cortical resorption canals, subperiosteal resorption of bone and, loss of the terminal cortex of tufts of phalanges
  • Severe osteopenia: Advanced cortical resorption canals, subperiosteal resorption of bone.

Pathology

  • May observe brown tumor of hyperparathyroidism
    • Contain abundance of giant cells in a mononuclear stroma
    • Histologically indistinguishable from giant cell tumors; diagnosis based on combination of clinical, radiologic, and pathologic data

Diagnosis and treatment

  • Correct life-threatening electrolyte disturbances
  • Identify and treat cause of increased PTH levels

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