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Bureaucrats, bureaucrats, nocaptcha, Administrators, Widget editors
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Anmol Pitliya (talk | contribs)
Bureaucrats, bureaucrats, nocaptcha, Administrators, Widget editors
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{{familytree | | | | | F01 | | F02 | | F03| | F04| | F05 | | F06 | | F07 | | | F08| |F01=Para-neoplastic syndrome: Parathyroid hormone related peptide|F02=Metaplasia: Hypercalcemia due to bone destruction|F03=Thiazide diuretics|F04=Lithium|F05=Milk alkali syndrome|F06=Vitamin D toxicity|F07=Sarcoidosis|F08=Immobilization}}
{{familytree | | | | | F01 | | F02 | | F03| | F04| | F05 | | F06 | | F07 | | | F08| |F01=Para-neoplastic syndrome: Parathyroid hormone related peptide|F02=Metaplasia: Hypercalcemia due to bone destruction|F03=Thiazide diuretics|F04=Lithium|F05=Milk alkali syndrome|F06=Vitamin D toxicity|F07=Sarcoidosis|F08=Immobilization}}
{{familytree/end}}
{{familytree/end}}
{| class="wikitable"
! colspan="5" |Differential diagnosis fo hyperparathyroidism on the basis of hypercalcemia
|-
! colspan="2" |Disorder
!Mechanism of hypercalcemia
!Clinical features
!Laboratory findings
|-
| rowspan="3" |Hyperparathyroidism
|Primary hyperparathyroidism
|Increase in [[secretion]] of [[parathyroid hormone]] (PTH) from a primary process in [[parathyroid gland]]. Parathyroid hormone causes increase in serum calcium.
|
* Usually asymptomatic
* Hypercalcemia detected on routine biochemical  panel
|
* '''↑ PTH'''
* '''↑ Ca'''
* '''''↓/N phosphate'''''
|-
|Secondary hyperparathyroidism
|Increase in [[secretion]] of [[parathyroid hormone]] from a secondary process. Parathyroid hormone causes increase in serum calcium.
|
* May present with history of:
** Chronic renal failure
** Vitamin D deficiency
|
* '''↑ PTH'''
* ''''''''↓/N''''''''  '''Ca'''
* ''''''''↑ phosphate''''''''
|-
|Tertiary hyperparathyroidism
|continuous elevation of [[parathyroid hormone]] even after successful treatment of the secondary cause of  elevated parathyroid hormone. Parathyroid hormone causes increase in serum calcium.
|
* Usually present with history of:
** Kidney transplant
* Usually hyperplasia of all four parathyroid glands
|
|-
| rowspan="2" |Malignancy
|Para-neplastic syndroms
|
|
|
|-
|Hypercalcemia due to bone destruction
|
|
|
|-
| rowspan="2" |Medication induced
|Lithium
|
|
|
|-
|Thiazide diuretics
|
|
|
|-
| rowspan="2" |Nutritional
|Milk-alkali syndrome
|
|
|
|-
|Vitamin D toxicity
|
|
|
|-
|Granulomatous disease
|Sarcoidosis
|
|
|
|}

Revision as of 18:00, 7 September 2017

There are three types of hyperparathyroidism and should be differentiated between each other. Hyperparathyroidism should be differeniated from other causes of hypercalcemia. Causes of hypercalcemia include:

  • Parathyroid related
    • Primary hyperparathyroidism
      • Typical primary hyperparathyroidism
      • Familial hypocalciuric hypercalcemia
    • Secondary hyperparathyroidism
    • Tertiary hyperparathyroidism
  • Non-parathyroid related
    • Malignancy
      • Para-neoplastic syndrome: Parathyroid hormone related peptide
      • Hypercalcemia due to bone destruction
    • Medication induced
      • Thiazide diuretics
      • Lithium
    • Nutritional
      • Milk alkali syndrome
      • Vitamin D toxicity
    • Granulomatous disease
      • Sarcoidosis
    • Surgical
      • Immobilization
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Hypercalcemia
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Related to Parathyroid gland
 
 
 
 
 
 
 
 
 
 
 
Unrelated to parathyroid gland
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Primary hyperparathyroidism
 
 
Secondary hyperparathyroidism
 
 
Tertiary hyperparathyroidism
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Typical primary hyperparathyroidism
 
Familial hypocalciuric hypercalcemia
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Malignancy
 
 
 
 
 
Medication induced
 
 
 
Nutritional
 
 
 
 
Granulomatous disease
 
 
Surgical
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Para-neoplastic syndrome: Parathyroid hormone related peptide
 
Metaplasia: Hypercalcemia due to bone destruction
 
Thiazide diuretics
 
Lithium
 
Milk alkali syndrome
 
Vitamin D toxicity
 
Sarcoidosis
 
 
Immobilization
 
Differential diagnosis fo hyperparathyroidism on the basis of hypercalcemia
Disorder Mechanism of hypercalcemia Clinical features Laboratory findings
Hyperparathyroidism Primary hyperparathyroidism Increase in secretion of parathyroid hormone (PTH) from a primary process in parathyroid gland. Parathyroid hormone causes increase in serum calcium.
  • Usually asymptomatic
  • Hypercalcemia detected on routine biochemical panel
  • ↑ PTH
  • ↑ Ca
  • ↓/N phosphate
Secondary hyperparathyroidism Increase in secretion of parathyroid hormone from a secondary process. Parathyroid hormone causes increase in serum calcium.
  • May present with history of:
    • Chronic renal failure
    • Vitamin D deficiency
  • ↑ PTH
  • '''↓/N''' Ca
  • '''↑ phosphate'''
Tertiary hyperparathyroidism continuous elevation of parathyroid hormone even after successful treatment of the secondary cause of elevated parathyroid hormone. Parathyroid hormone causes increase in serum calcium.
  • Usually present with history of:
    • Kidney transplant
  • Usually hyperplasia of all four parathyroid glands
Malignancy Para-neplastic syndroms
Hypercalcemia due to bone destruction
Medication induced Lithium
Thiazide diuretics
Nutritional Milk-alkali syndrome
Vitamin D toxicity
Granulomatous disease Sarcoidosis
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