PTH OverviewPTH function:
↑ PTH (intact PTH)
↓ Vit D (may be normal)
↑ cAMP in urine
↑ PTH (intact PTH)
↓ Vit D
May present with:
- Weakness and constipation (“groans”)
- Abdominal/flank pain (kidney stones, acute pancreatitis)
- Depression (“psychiatric overtones”)
- Most often in chronic renal disease (causes hypovitaminosis
D, ↓ Ca2+
- ↓ GI Ca2+ absorption
- Hyperparathyroidism is present in >50% of patients who have a GFR <60 mL/min.
- Independently associated with increased mortality and an increased prevalence of cardiovascular disease.
- In patients with stage 4 chronic kidney disease, monitoring:
- Serum Ca and phos levels q 3–6 Mo
- Bone-specific Alk-phos q 6–12 Mo
- Goal = normalizing these values.
Ref: ITE 2014, Q31
- Squamous Cell Carcinoma (lung) = PTH-Like (PTHrP) =
Hypercalcemia = Renal Calculi
- Renal cell carcinoma,
- Breast cancer
1. DXA Scan
2. Sestamibi scannig and Ultrasonography
3. +/- MRI, CT Neck
1. IV Fluids (Oral Hydration 2-3 L daily)
2. Rarely Lasix AFTER Hydration.
2. Bisphosphonates IV for everyone (Pamidronate) - Only useful temporarily, may take 2-3 days to reach maximum effect.
3. Calcintonin - for secondary Hyperparathyroidism in hemodialysis pt and in moderate-to-severe primary hyperparathyroidism unamenable to surgery.
|All Symptomatic/Pregnant patients||Asymptomatic patient with:|
ITE 2013 - Question # 13
A 47-year-old postmenopausal female falls while carrying groceries into her house and sustains a right distal radial fracture. A chemistry panel reveals a calcium level of 11.2 mg/dL (N 8.6–10.6) and further evaluation leads to a diagnosis of primary hyperparathyroidism.
Which one of the following is the best course of treatment for this patient?
A) Estrogen replacement therapy
B) Long-term bisphosphonate therapy
C) Daily furosemide treatment with increased oral fluids
D) Elimination of calcium and vitamin D from the diet
E) Referral to a surgeon for consideration of parathyroidectomy
Ref: Marcocci C, Cetani F: Clinical practice. Primary hyperparathyroidism. N Engl J Med 2011;365(25):2389-2397. 2) Pallan S, Rahman MO, Khan AA: Diagnosis and management of primary hyperparathyroidism. BMJ 2012;344:e1013
44. A 56-year-old male with diabetes mellitus, hypertension, and chronic
renal insufficiency presents for follow-up of his chronic medical
conditions. Results of his most recent metabolic panel included an estimated
glomerular filtration rate of 30 mL/min/1.73 m2 (N >60) and a calcium level
of 10.4 mg/dL (N 8.5–10.2). Medication reconciliation reveals he is not
taking the sevelamer (Renagel, Renvela) prescribed by the consulting
You explain to the patient that he should be taking sevelamer to lower his serum calcium. The drug accomplishes this by
A) blocking the effect of parathyroid hormone
B) blocking excessive vitamin D levels, thus decreasing intestinal calcium absorption and increasing renal calcium excretion
C) blocking intestinal absorption of phosphate, which lowers parathyroid hormone secretion
D) directly blocking excessive calcium absorption in the intestines
E) directly increasing the renal excretion of both calcium and phosphate
Ref: Longo DL, Fauci AS, Kasper DL, et al (eds): Harrison’s Principles of Internal Medicine, ed 18. McGraw-Hill, 2012, pp