Primary parathyroid hyperplasia

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Synonyms and keywords:

Classification

• Primary parathyroid hyperplasia
• Secondary parathyroid hyperplasia

Pathophysiology

• Parathyroid hyperplasia is the diffuse enlargement of the parathyroid glands and is a cause of primary hyperparathyroidism.
• In ~50% of cases there is asymmetric enlargement of the parathyroid glands.

Associated Conditions

• Multiple endocrine neoplasia I (MEN I)
• Multiple endocrine neoplasia II A (MEN IIA)
• Isolated familial hyperparathyroidism

Gross Pathology

• Classically all parathyroid glands are involved; however, some may be spared making it difficult to differentiate this from parathyroid adenoma.

Microscopic Pathology

• Classically have abundant adipose tissue
• +/-Water-clear cells ("water-clear cell hyperplasia").

Causes

• Primary parathyroid hyperplasia

• Sporadic (80%): associated with exposure to radiation and lithium
• Familial (20%): associated with MEN 1 and MEN 2a

• Secondary parathyroid hyperplasia

• Renal failure

Differentiating type page name here from other Diseases

• Prathyroid adenoma
• Parathyroid carcinoma

Epidemiology and Demographics

Age

Females are more commonly affected with parathyroid hyperplasia than males. The females to male ratio is approximately 3:1.

Risk Factors

• Multiple endocrine neoplasia I
• Multiple endocrine neoplasia II A
• Isolated familial hyperparathyroidism

Natural History, Complications and Prognosis

• Depending on the extent of the tumor at the time of diagnosis, the prognosis may vary. However, the prognosis is generally regarded as excellent.

Complications

• Kidney stones
• Osteitis fibrosa cystica

Diagnosis

Diagnostic Criteria

If available, the diagnostic criteria are provided here.

History

A directed history should be obtained to ascertain

Symptoms

• Constipation
• Bone fractures or bone pain
• Nausea
• Lethargy
• Muscle pain

Past Medical History=

Social History

Alcohol

The frequency and amount of alcohol consumption should be characterized.

Laboratory Findings

• Calcium
• Phosphorus
• Magnesium
• PTH
• Vitamin D levels
• A 24-hour urine test

Chest X Ray

• Bone x-rays

Other Imaging Findings

• Bone density test (DXA)
• Nuclear medicine (Tc-99m MIBI) is the current modality of choice.

Treatment

Surgery

• Surgery is the mainstay of treatment for parathyroid hyperplasia. Three and a half part of the glands are removed during surgery.

Secondary Prevention

• Genetic screening for patients with family history of MEN syndrome.