Let’s take a look at primary hyperparathyroidism
in greater detail.
We said that extremely, if it’s hypocalcaemia
90 percent of your patients if you’re thinking
about adenoma, which is exactly what we’re
seeing here in the picture, an adenoma within
your parathyroid gland.
Solitary, sporadic 85 percent of the time.
It’s seen on a scan known as your Sestamibi
Scan and the darkened area that you see there
will be a solitary adenoma in which it’s
extremely darkened and enlarged.
Focus upon your Sestamibi Scan.
10 to 15 percent hyperplasia of all four glands
and majority of your primary hyperparathyroidism
would be a solitary adenoma as seen here in
the scan; 10 to 15 percent might be hyperplasia
of all four glands.
Perhaps carcinoma, paraneoplastically, squamous
and renal-renal cell carcinoma, how will this
then produce your hypoparathyroidism?
PTHrp, so ectopic production of PTHrp resulting
in hypercalcemia where your PTH is actually
Risk factors, irradiation to head and neck;
usually asymptomatic, diagnosed routine labs.
Typical symptoms, if you’re thinking about
hypercalcemia, would not be tetany; fatigue,
nausea, constipation… looking at GI symptoms
and you’re looking at neurologic issues
Dizziness, fatigue, worst case scenario might
even be stupor and coma.
If it’s hyperparathyroidism, you take a
look at the bone and its being broken down…
PTH does not promote bone mineralization,
it promotes resorption of calcium from the
Thus, in the X-ray that we’re seeing is
our areas of the bone where it’s extremely
lucent, not opaque.
Remember, if it’s osteopetrosis, if it’s
Paget’s disease of the bone, especially
the third pattern, triphasic, you would have
You’ve heard of marble bone disease, that’s-that’s
opaque, extremely white, so lucent.
What may then happen with extreme destruction
of the bone and such, obviously fractures
and worst case scenario might be called osteitis
fibrosa cystica… osteitis fibrosa cystica.
Check forearm and you do a bone density test.
Effects of hyperparathyroidism, you’ll notice
in the middle figure here in the-in the thyroid
and then within the thyroid, we have our parathyroids
and you find a solitary nodule or adenoma
and with this, you are producing excess PTH
or primary hyperparathyroidism.
What we’ll take a look at in greater detail
will be the overview of each one of these
organ systems that are affected.
Let’s now go into the bone and with the
assistance of PTH, you might be then breaking
down your bone excessively.
When you do so, you... this cartoon is showing
you is osteitis fibrosa cystica, but that
area that’s being pointed to is actually
called “a brown tumour”, but that’s
a misnomer, it’s not a tumour within the
bone, it’s not a tumour, but it is is a
cavity that’s being filled with haemosiderin.
Therefore, on imaging study, it might actually
look like a tumour, but it’s not, it’s
called osteitis fibrosa cystica, breaking
down of your bone.
Fractures may occur because, once again, there’s
weakening of your bone.
Effects of too much or excessive PTH on your
On the kidney, you might then start reabsorbing
more of your calcium.
What may then happen, interesting enough,
is the fact that you might actually develop
calcium stones, effect of hyperparathyroidism.
So, it all depends and with all these calcium,
remember even if you’re reabsorbing your
calcium from your kidney, at some point, it
needs to get filtered, doesn’t it?
Because you just said you have hypercalcemia.
So, be careful.
So, therefore, it’s very possible that the
patient may actually be suffering from calcium
stones, polyuria, because of more or less
your osmotic diuresis.
On the brain type of effects that you will
find with hypercalcemia, depression, neurologic
issues such as seizures.
And then in your intestine, you may then find
gall stones; peptic ulcers especially in the
duodenum and acute pancreatitis.
Keep all these together, please, when dealing
with effects of hypoparathyroidism.
As a result of hypercalcemia, you have different
organ systems that are being affected.