Etiology, clinical manifestations, diagnosis, and management of primary hyperparathyroidism
Diagnostic evaluation: Laboratory and imaging studies for primary hyperparathyroidism
Primary hyperparathyroidism is a condition leading to excessive parathyroid hormone secretion, resulting in hypercalcemia. This blog discusses its etiology, clinical manifestations, diagnostic evaluation, and treatment approaches including surgery and medical management.
Etiology, Clinical Manifestations, Diagnosis, and Management of Primary Hyperparathyroidism
Introduction
Primary hyperparathyroidism (PHPT) is a condition characterized by excessive secretion of parathyroid hormone (PTH), leading to hypercalcemia. It is commonly caused by a benign adenoma or hyperplasia of the parathyroid glands.
Etiology
The most common cause of PHPT is a solitary parathyroid adenoma, accounting for about 85% of cases. Other causes include parathyroid hyperplasia and, rarely, parathyroid carcinoma.
Clinical Manifestations
- Hypercalcemia symptoms such as fatigue, weakness, and depression
- Renal complications including nephrolithiasis and polyuria
- Gastrointestinal issues like nausea, vomiting, and constipation
- Musculoskeletal symptoms such as osteoporosis and bone pain
- Neurological effects including cognitive dysfunction
Diagnostic Evaluation
Laboratory Tests
- Serum calcium and PTH levels (elevated PTH and hypercalcemia suggest PHPT)
- Vitamin D levels to assess deficiency or insufficiency
- Urinary calcium excretion to differentiate from familial hypocalciuric hypercalcemia
Imaging Studies
- Neck ultrasound for gland evaluation
- Sestamibi scan to localize adenomas
- CT/MRI for detailed imaging in complex cases
Management
Surgical Approach
Parathyroidectomy is the treatment of choice for symptomatic patients or those meeting surgical criteria. Minimally invasive approaches are preferred.
Medical Management
- Hydration to reduce serum calcium
- Bisphosphonates to prevent bone loss
- Calcimimetics for patients unsuitable for surgery
Conclusion
Primary hyperparathyroidism requires prompt diagnosis and appropriate management to prevent complications. Advances in imaging and surgical techniques have improved outcomes for patients.
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