endocrine and metabolic disorders
Hyperparathyroidism
Key Points
Primary hyperparathyroidismcauses hypercalcemia which is often asymptomatic. Diagnosis is made by finding elevated PTH levels in a patient with hypercalcemia. Primary hyperparathyroidism is most often due to solitary adenomas but these can be multiple in hereditary multiple endocrine neoplasia syndromes. Treatment can be conservative in asymptomatic patients but usually requires surgical parathyroidectomy in patients with symptoms, severe hypercalcemia, or severe osteoporosis. Secondary hyperparathyroidismis most often due to advanced renal disease and related to decreasedvitamin Dand calcium levels as well as persistent hyperphosphatemia. Medical treatment is with continuous reduction in phosphate intake, phosphate binders,vitamin D, and calcimimetics. Surgery is reserved for patients with severe and uncontrolled hyperparathyroidism. 