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Hyperparathyroidism

Rare Hyperparathyroidism


Presentation

  • This article highlights the importance of proper diagnosis and management of dental patients presenting with a brown tumor.[ncbi.nlm.nih.gov]
  • Presentation Almost all patients with CKD have SHPT to some degree, so the clinical presentation is often that of kidney disease.[patient.info]
  • CONCLUSIONS: In the present case, we speculate that hypercalcemia probably due to secondary hyperparathyroidism that had developed during steroid therapy deteriorated the parkinsonism.[ncbi.nlm.nih.gov]
  • In the majority of cases, PHPT is the presenting symptom, but up to 30 % of HPT-JT cases initially present with an ossifying fibroma of the maxillofacial bones.[ncbi.nlm.nih.gov]
  • CASE PRESENTATION: Here, we present the case of a 58-year-old Thai woman with severe hyperparathyroidism who received a living-related kidney transplant from her 35-year-old son.[ncbi.nlm.nih.gov]
Fatigue
  • We present a case of a 54-year-old woman with fatigue, myalgia, and poor concentration who was found to have hypercalcemia (corrected calcium, 11.2 mg/dL) and elevated parathyroid hormone level (112 pg/mL), laboratory values consistent with primary hyperparathyroidism[ncbi.nlm.nih.gov]
  • Patient will present as a 62-year-old female complaining of joint pain, polyuria, polydipsia, and generalized fatigue. The patient reports a history of recurrent kidney stones and depression.[smartypance.com]
  • We ask about general symptoms (anxious mood, depressed mood, fatigue, pain, and stress) regardless of condition. Last updated: May 13, 2019[patientslikeme.com]
  • When she explained her symptoms, such as low bone density, fatigue and kidney stones, Russell ordered additional tests. “Her symptoms were not consistent with that I would have expected,” he recalls.[hopkinsmedicine.org]
  • While each child may experience symptoms differently, some of the most common include: kidney pain (due to kidney stones ) bone pain aches and pains abdominal pain nausea vomiting chronic fatigue excessive urination confusion muscle weakness The symptoms[childrenshospital.org]
Anorexia
  • The symptoms of hyperparathyroidism are related to hypercalcaemia and include General weakness; lethargy; muscle weakness Polyuria and polydipsia Anorexia, vomiting, abdominal pain and constipation Depression, psychosis and memory loss Bone and joint[diapedia.org]
  • Gastrointestinal System Anorexia, constipation and nausea can occur as a result of hyperparathyroidism. Peptic ulcer disease occurs in 15 percent of patients.[aafp.org]
  • Anorexia; nausea and vomiting; constipation; abdominal pain; peptic ulcer disease (hypercalcaemia can increase gastric acid secretion); acute pancreatitis. Polyuria, polydipsia, dehydration. Renal colic, haematuria, hypertension.[patient.info]
Constipation
  • The range of signs and symptoms include: Muscle weakness Bone and joint aches and pains Kidney stones Excessive urination Feeling thirsty more than normal Constipation Fragile bones that may easily fracture (osteoporosis) Depression Pancreatitis Stomach[ucdenver.edu]
  • If present, common manifestations of hypercalcemia include weakness and fatigue, depression, bone pain, muscle soreness (myalgias), decreased appetite, feelings of nausea and vomiting, constipation, polyuria, polydipsia, cognitive impairment, kidney stones[en.wikipedia.org]
  • […] medicines Having had radiation treatment in the head or neck Symptoms Symptoms of the condition can include: Muscle weakness Depression Tiredness Confusion and memory loss Poor memory Nausea and vomiting Pain in the stomach area (abdomen) Hard stools (constipation[fairview.org]
  • Although hyperparathyroidism may not cause any symptoms, some patients might experience: Feeling fatigued and weak Constipation Loss of appetite Joint pain Increased thirst Frequent urination Kidney pain, caused by kidney stones (calcium deposits in the[dartmouth-hitchcock.org]
  • These may include: Fatigue or lack of energy; sluggishness Bone pain, bone loss, or broken bones Constipation Hypertension (high blood pressure) Poor appetite, sometimes with nausea Kidney stones Depression Mood swings; changes in personality Memory problems[roswellpark.org]
Nausea
  • While each child may experience symptoms differently, some of the most common include: kidney pain (due to kidney stones ) bone pain aches and pains abdominal pain nausea vomiting chronic fatigue excessive urination confusion muscle weakness The symptoms[childrenshospital.org]
  • Symptoms may include: Kidney pain (due to the presence of kidney stones) Diminished bone density that causes bone pain Aches and pains Abdominal pain Nausea Vomiting Fatigue Excessive urination Confusion Muscle weakness The symptoms of hyperparathyroidism[chw.org]
  • A person who has mild hyperparathyroidism may have some of the following symptoms: Joint pain Muscle weakness Fatigue Depression Trouble concentrating Loss of appetite More severe cases of hyperparathyroidism may produce these symptoms: Nausea and vomiting[my.clevelandclinic.org]
  • […] other endocrine tumors Having certain kidney problems Taking certain medicines Having had radiation treatment in the head or neck Symptoms Symptoms of the condition can include: Muscle weakness Depression Tiredness Confusion and memory loss Poor memory Nausea[fairview.org]
  • […] cause any symptoms, some patients might experience: Feeling fatigued and weak Constipation Loss of appetite Joint pain Increased thirst Frequent urination Kidney pain, caused by kidney stones (calcium deposits in the kidneys) Bone pain or tenderness Nausea[dartmouth-hitchcock.org]
Loss of Appetite
  • A person who has mild hyperparathyroidism may have some of the following symptoms: Joint pain Muscle weakness Fatigue Depression Trouble concentrating Loss of appetite More severe cases of hyperparathyroidism may produce these symptoms: Nausea and vomiting[my.clevelandclinic.org]
  • Although hyperparathyroidism may not cause any symptoms, some patients might experience: Feeling fatigued and weak Constipation Loss of appetite Joint pain Increased thirst Frequent urination Kidney pain, caused by kidney stones (calcium deposits in the[dartmouth-hitchcock.org]
  • […] of appetite The health care provider will do a physical exam and ask about symptoms.[nlm.nih.gov]
  • There are also other patients who have nonspecific symptoms, such as fatigue, weakness, depression, and loss of appetite.[britannica.com]
  • […] of appetite Nausea Muscular weakness Muscle pain Depression Personality changes Stupor and possibly coma Itching of the skin Blurred vision (because of cataracts) Bone pain or tenderness Signs and tests: Serum calcium is increased.[uclahealth.org]
Polydipsia
  • Patient will present as a 62-year-old female complaining of joint pain, polyuria, polydipsia, and generalized fatigue. The patient reports a history of recurrent kidney stones and depression.[smartypance.com]
  • The symptoms of hyperparathyroidism are related to hypercalcaemia and include General weakness; lethargy; muscle weakness Polyuria and polydipsia Anorexia, vomiting, abdominal pain and constipation Depression, psychosis and memory loss Bone and joint[diapedia.org]
  • Cardiovascular disease Left ventricular hypertrophy Arterial hypertension Shortened QT interval Kidney Nephrolithiasis , nephrocalcinosis Polyuria , polydipsia Musculoskeletal system Bone, muscle, and joint pain Pseudogout Osteitis fibrosa cystica ( cyst-like[amboss.com]
  • If present, common manifestations of hypercalcemia include weakness and fatigue, depression, bone pain, muscle soreness (myalgias), decreased appetite, feelings of nausea and vomiting, constipation, polyuria, polydipsia, cognitive impairment, kidney stones[en.wikipedia.org]
  • Polyuria, polydipsia, dehydration. Renal colic, haematuria, hypertension. Long-standing hypercalcaemia causes corneal calcification, which is usually asymptomatic.[patient.info]
Osteoporosis
  • J Clin Endocrinol Metab 2000 / 85 (1) / 95-101., Riggs BL, et al, A unitary model for involutional osteoporosis: estrogen deficiency causes both type I and type II osteoporosis in postmenopausal women and contributes to bone loss in aging men. J.[4.waisays.com]
  • Surgery is recommended for those younger than 50 years of age and those with osteoporosis, renal complications, or clinically significant hypercalcemia.[doi.org]
  • Standard treatments for osteoporosis ( bisphosphonates ) work well to improve bone mineral density in osteoporosis due to primary hyperparathyroidism. In people with normocalcaemic hyperparathyroidism, we don’t yet know what the best treatment is.[yourhormones.info]
  • They were diagnosed with hypercalcemia, hypophosphatemia, high PTH concentrations, and osteoporosis. A single parathyroid adenoma was confirmed in each patient by Tc-MIBI scintigram, neck ultrasonography and computed tomographic scanning.[doi.org]
  • Osteoporosis typically occurs when you have too much calcium in your blood and not enough calcium in your bones for a prolonged period. Osteoporosis puts you at a higher risk for bone fractures.[healthline.com]
Arthralgia
  • There is arthralgia, fractures, bowing of long bones and often gross deformities of the spine and chest. Bibliography G. Engel: Über einen Fall von cystoider Entartung des ganzen Skelettes. Giessen, F. C. Pietsch, 1864. F.[whonamedit.com]
  • Arthralgias can occur at the medium and large joints. The features may mimic polymyalgia rheumatica. Weakness, easy fatigability, and atrophy can occur, particularly at the lower extremities.[rheumatologyadvisor.com]
Long Arm
  • It has an autosomal dominant pattern of inheritance, and is associated with mutations that deactivate the cell division cycle protein 73 homolog (CDC73) gene, also known as hyperparathyroidism 2 (HRPT2), located on the long arm of chromosome 1, that encodes[ncbi.nlm.nih.gov]
Kidney Failure
  • Common conditions include: Conditions that make it hard for the body to remove phosphate Kidney failure Not enough calcium in the diet Too much calcium lost in the urine Vitamin D disorders (may occur in children who do not eat a variety of foods, and[nlm.nih.gov]
  • In chronic kidney failure the problem is more specifically failure to convert vitamin D to its active form in the kidney. The bone disease in secondary hyperparathyroidism caused by kidney failure is termed renal osteodystrophy.[en.wikipedia.org]
  • Most patients with this form of hyperparathyroidism also have chronic kidney failure. Kidney failure causes an abnormality in calcium regulation due to the body's inability to regulate calcium and phosphorus excretion in the urine.[montefiore.org]
  • It's associated with very advanced kidney failure (usually requiring dialysis ). People with tertiary hyperparathyroidism are almost always under the care of kidney specialists.[nhs.uk]
  • […] with very long-standing kidney failure and dialysis Thyroid and Parathyroid Glands: Posterior (Back) View Copyright Nucleus Medical Media, Inc.[uvahealth.com]
Polyuria
  • Polyuria can occur with renal failure. Cardiac arrhythmias can occur and even coma.[smartypance.com]
  • The symptoms of hyperparathyroidism are related to hypercalcaemia and include General weakness; lethargy; muscle weakness Polyuria and polydipsia Anorexia, vomiting, abdominal pain and constipation Depression, psychosis and memory loss Bone and joint[diapedia.org]
  • Cardiovascular disease Left ventricular hypertrophy Arterial hypertension Shortened QT interval Kidney Nephrolithiasis , nephrocalcinosis Polyuria , polydipsia Musculoskeletal system Bone, muscle, and joint pain Pseudogout Osteitis fibrosa cystica ( cyst-like[amboss.com]
  • If present, common manifestations of hypercalcemia include weakness and fatigue, depression, bone pain, muscle soreness (myalgias), decreased appetite, feelings of nausea and vomiting, constipation, polyuria, polydipsia, cognitive impairment, kidney stones[en.wikipedia.org]
  • Polyuria, polydipsia, dehydration. Renal colic, haematuria, hypertension. Long-standing hypercalcaemia causes corneal calcification, which is usually asymptomatic.[patient.info]
Metrorrhagia
  • The condition was significantly contributed by increasingly more frequent and longer episodes of metrorrhagia. Despite all therapeutic measures that were taken, systemic inflammatory response syndrome (SIRS) developed, and fatal outcome occurred.[ncbi.nlm.nih.gov]
Memory Impairment
  • Patients may have neurocognitive effects such as anxiety, depression or memory impairment or gastrointestinal disturbances such as abdominal pain or constipation. Neuromuscular weakness may ensue.[clinicaladvisor.com]
Bradykinesia
  • CASE PRESENTATION: An 83-year-old woman with a history of right thalamic hemorrhage and drug-induced parkinsonism, was admitted due to worsening of parkinsonian symptoms including mask-like face, bradykinesia, freezing of gait, and rigidity.[ncbi.nlm.nih.gov]

Workup

  • While inpatient, goal is to stabilize significant symptoms of hypercalcemia and order workup to establish diagnosis of PHPT, which can subsequently be completed in the outpatient setting.[clinicaladvisor.com]

Treatment

  • It turns out that lithium, a mainstay in the treatment of bipolar disorder, is associated with an increased incidence of hyperparathyroidism.[web.archive.org]
  • Treatment See also separate Hypercalcaemia article.[patient.info]
  • However, the biochemical definition of vitamin D deficiency and its treatment are subject to much debate.[ncbi.nlm.nih.gov]
  • Medical treatment success is related to calcium sensing receptor (CaSR) genotype. We report a 4-day-old infant who presented with hyperbilirubinemia, poor feeding, weight loss, severe hypotonia and was ultimately diagnosed with NSHPT.[ncbi.nlm.nih.gov]
  • More information Patient: Hyperparathyroidism Factsheet on this disorder resulting from an excessive secretion of parathyroid hormone, the causes of the different forms, their presentation, differential diagnosis, investigations, treatment and complications[curlie.org]

Prognosis

  • Support Groups: Expectations (prognosis): The outlook varies depending on the specific type of hyperparathyroidism.[uclahealth.org]
  • However, if you have secondary or tertiary hyperparathyroidism, the prognosis tends to be worse. This is because it is usually caused by underlying stage 5 CKD.[patient.info]
  • Prognosis Mortality/Morbidity Most patients, who are predominantly middle aged or elderly, present with mild elevations of serum calcium and are not overtly symptomatic.[emedicine.com]
  • Prognosis and Patient Counseling. Patients who are asymptomatic will need their primary care doctor to follow their calcium levels annually and to perform bone density testing every 1-2 years to evaluate for osteoporosis.[clinicaladvisor.com]

Etiology

Each different form of hyperparathyroidism has its own etiologic factors that are grouped together by type [2]:

Epidemiology

  • Research: Abstracts of the ... annual meeting of the Society for Epidemiologic Research Standardnummern ISSN der Vorlage: 0002-9262 ISSN der Parallelausgabe: 1476-6256 OCLC-Nr.: 231011494 Diesen Titel auf die Merkliste setzen American journal of epidemiology[zdb-katalog.de]
  • References: [1] Epidemiology Primary hyperparathyroidism Lifetime incidence : 1/80 Sex : (3:1) Age : most cases occur after age 50 Prevalence : 0.1–0.5% Epidemiological data refers to the US, unless otherwise specified.[amboss.com]
  • Working Group on Epidemiology and Prevention of Cardiovascular Diseases: Meeting of the Working Group of the European Society of Cardiology on Epidemiology and Prevention of Cardiovascular Diseases 9,Suppl. 1 von: Weltgesundheitsorganisation.[zdb-katalog.de]
  • Introduction Clinical definition disorder characterized by the over secretion of parathyroid hormone (PTH) by 1 or more of the parathyroid glands can be of primary, secondary, or tertiary causes Epidemiology demographics occurs in 0.1% of the population[medbullets.com]
  • Introduction I ncreased parathyroid hormone (PTH) production that may be of primary, secondary or tertiary causes Epidemiology incidence occurs in 0.1% of the population 90% result form a single adenoma remaining 10% from parathyroid hyperplasia demographics[orthobullets.com]
Sex distribution
Age distribution

Pathophysiology

  • Epidemiology incidence occurs in 0.1% of the population 90% result form a single adenoma remaining 10% from parathyroid hyperplasia demographics more common in women hyperparathyroidism and maligncacy make up the majority of patients with hypercalcemia Pathophysiology[orthobullets.com]
  • ., reduced exposure to sunlight, nutritional deficiency, liver cirrhosis ) Cholestasis Tertiary hyperparathyroidism Caused by persistent sHPT References: [1] [2] [3] Pathophysiology Physiological secretion of PTH See disorders of calcium balance .[amboss.com]
  • Although the pathophysiology is not known, it is suggested that PTH or calcium deposition may inhibit uric acid excretion in the proximal renal tubule.[rheumatologyadvisor.com]
  • […] patients with overtly symptomatic hyperparathyroidism (eg, those with urinary tract stones, bone pain, cognitive abnormalities) and those with marked hypercalcemia (calcium levels 10.2 mg/dL) should be referred for consideration for parathyroidectomy. [4] Pathophysiology[emedicine.com]

Prevention

  • Your doctor may also recommend lifestyle changes such as monitoring your calcium intake, drinking water to prevent kidney stones, exercising regularly and quitting smoking to help prevent bone loss.[nm.org]
  • Patients with secondary hyperparathyroidism are often initially treated with medications to prevent buildup of phosphorus in the body and to inhibit the parathyroid hormone from overproduction with the medication cincalcet.[montefiore.org]
  • Treatment of NSHPT traditionally includes hydration and bisphosphonates; however newer calcimimetic agents, such as cinacalcet, are now being utilized to prevent or delay parathyroidectomy which is technically difficult in the newborn.[ncbi.nlm.nih.gov]
  • Prevent Hyperparathyroidism Adequate calcium intake may play a role in preventing hyperparathyroidism in women. Try to get recommended levels of calcium through dietary choices and supplements. MAKE AN APPOINTMENT Call 434.243.3675 .[uvahealth.com]
  • Hormone replacement therapy (HRT) does not address the underlying causes of excess PTH but helps to prevent bone from demineralizing as a result of excess PTH in the blood.[physio-pedia.com]

Summary

When the parathyroid glands become overactive and excessively produce parathyroid hormone PTH, which is responsible for the regulation of phosphate and calcium levels in the body, it leads to hyperparathyroidism [1]. Hyperparathyroidism is divided into three forms, primary hyperparathyroidism, secondary hyperparathyroidism, and tertiary hyperparathyroidism.

It should be noted that there are other reasons for the overproduction of PTH. A person could be suffering from a glandular disorder like hyperthyroidism which leads to hypercalcemia, or there could be low calcium levels in the body due to a vitamin D deficiency or a chronic kidney disease.

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Last updated: 2017-08-09 15:09