Parathyroid Hyperplasia( %10 ) Parathyroid Carcinoma < %1
Hyperparathyroidism Primary Hyperparathyroidism Single Adenoma( %85 ) Multiple Adenoma(%5 ) Parathyroid Hyperplasia( %10 ) Parathyroid Carcinoma < %1 Parathyroid Hyperplasia( %10 ) Parathyroid Carcinoma < %1
Hyperparathyroidism Primary Hyperparathyroidism Single Adenoma( %85 ) Multiple Adenoma(%5 ) Parathyroid Hyperplasia( %10 ) Parathyroid Carcinoma < %1 Secondary to Hypocalcemia Renal Calcium Leak
Hyperparathyroidism Secondary Hyperparathyroidism Tertiary Hyperparathyroidism Secondary to Hypocalcemia Renal Calcium Leak Dietary Calcium Malabsorption Vit D deficiency Parathroid Adenoma CLINICAL MANIFESTATION
50-80% asymptomatic GI : loss of apetite,vometing, abdominal pain , constipation ,pancreatitis Central nervous system: lethargy, drowsinesscoma , hyporeflexia Neuromuscular :easy fatigability,proximal weakness, muscle atrophy, paresthesia , carpal tunnel Cardiac : HTN, arrythmias, CHF Kidney : Nephrolithiasis (calcium oxalate and calcium phosphate )may lead to infection and loss of renal function : Nephrocalcinosis may decreased renal function Rheumatologic Manifestation
OfHyperparthyroidism Osteitis Fibrosa Cystica Osteoporosis Erosive Arthritis Chondrocalcinosis Ectopic Calcification Subchondral Fracture Myopathy Joint Laxity CTS Richets ( child ) Osteitis Fibrosa Cystica
Most Specific pathologic Finding Number of Trabecula GiantMultinuclearOsteoclast Replacement of BM with Fibrosis Radiology : Bone Cyst( Brown tumor ) Pepper + Salt Subperiosteal Resorption PATHOLOGY Decreased number of trabecula Giant multinuclear osteoclast
Replaced bone marrow with fibrosis Osteoclastreabsorption Normal skull Salt and pepper in Skull SALT AND PEPPER DistalClavicularResorption SUBPERIOSTEAL RESORPTION
In radial aspect of figers (2,3) Subperiosteal Resorption Phalanx resorption Brown Tumor BROWN TUMOR Brown Tumor Brown Tumor Brown Tumor ( Histology) Normal sacroiliac joint Normalsacroiliac Pseudowidening of Sacroiliac Joints Soft tissue calcification( Hyperpara) Softtissuecalcification Normallumbosacral Osteoporosis BONE CYST Chondocalcinosis Raggerr gersy Secondary Hyperparathyroidism Laboratory : Imaging : Detection of Primary hypepara
Ca,P, Alk Ph , PTH High Frequency Ultrasound TC99 Pertechnetate + Thalium TC99 SestamibiScanning CervicalMRIScanning Intravenous Digital Subtraction Angiography 2- Medical Estrogen Calcitonin Biphosphonate Others
Treatment of Primary Hyperpara 2- Medical Estrogen Calcitonin Biphosphonate Others 1- Surgical : Treatment of Primary Hyperpara age < 50 y
ca > 1/ 6 mg / 100 ( upper limit ) age matched Clcr > %30 History of LifethreateningCa 24 h urinary Ca > 400 mg Z Score < -2 SD