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11-29-2009, 09:49 AM
HYPERPARATHYROIDISM

"The disease of bones, stones and abdominal groans"
Types:
─ 1ry: "Commonest due to « parathyroid adenoma 85%
or « hyperplasia of parathyroids
─ 2 ry: ­ hormone as a feedback to low Ca. bl. level.
─Tertiary: autonomous hyperplastic tissue due to long period of hypocalcaemia e.g. in renal failure
Clinical Picture:
─ Mobilization of Ca. from bones «
(1) Bone cysts "lower jaw"
(2) Path. fr. & wedging of vertebrae.
─­ Ca excretion « recurrent multiple stones which may lead to renal damage.
─­Gastric & pancreatic secretion « peptic ulcer and pancreatitis.
Diagnosis:
─ Blood « ­ bl. calcium with » bl. phosphorous.
─Urine « ­ urine Ca & phosphorous.
─ X-ray on bones « bone cysts.
─ Radio immunoassay «­ parathormone hormone.
Differential Diagnosis:
1. From other causes of hypercalcemia: bone secondaries, Pagetĺs disease of bone, sarcoidosis.
2. Renal tubular acidosis.
3. Hypervitaminosis D.
Treatment:
1- Parathyroid adenoma « Excise the adenoma.
2- Parathyroid hyperplasia « Excise 3 glands and most of the 4th. The remaining part may be transplanted to the Biceps muscle to facilitate re-exploration if needed.

SOURCE: Prof. AYMAN SALEM'S BOOK
Copyright: Vascular Society of Egypt (Vascular Society of Egypt (http://www.vsegypt.org/)) &Medical Educational web (Medical Educational web (http://www.meduweb.com/))
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