Primary parathyroid hyperplasia

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

Synonyms and keywords:

Overview

Historical Perspective

Classification

Pathophysiology

Genetics

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[1]
  • +/-Water-clear cells ("water-clear cell hyperplasia").

Causes

Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.

Common Causes

Causes by Organ System

Cardiovascular No underlying causes
Chemical / poisoning No underlying causes
Dermatologic No underlying causes
Drug Side Effect No underlying causes
Ear Nose Throat No underlying causes
Endocrine No underlying causes
Environmental No underlying causes
Gastroenterologic No underlying causes
Genetic No underlying causes
Hematologic No underlying causes
Iatrogenic No underlying causes
Infectious Disease No underlying causes
Musculoskeletal / Ortho No underlying causes
Neurologic No underlying causes
Nutritional / Metabolic No underlying causes
Obstetric/Gynecologic No underlying causes
Oncologic No underlying causes
Opthalmologic No underlying causes
Overdose / Toxicity No underlying causes
Psychiatric No underlying causes
Pulmonary No underlying causes
Renal / Electrolyte No underlying causes
Rheum / Immune / Allergy No underlying causes
Sexual No underlying causes
Trauma No underlying causes
Urologic No underlying causes
Dental No underlying causes
Miscellaneous No underlying causes

Causes in Alphabetical Order

  • A...
  • Z...

Make sure that each diagnosis is linked to a page.

Differentiating type page name here from other Diseases

Epidemiology and Demographics

Age

Gender

Race

Developed Countries

Developing Countries

Risk Factors

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

Screening

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=

Family History

Social History

Occupational

Alcohol

The frequency and amount of alcohol consumption should be characterized.

Drug Use

Smoking

Allergies

Physical Examination

Appearance of the Patient

Vital Signs

Skin

Head

Eyes

Ear

Nose

Mouth

Throat

Heart

Lungs

Abdomen

Extremities

Neurologic

Genitals

Other

Laboratory Findings

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

Electrolyte and Biomarker Studies

Electrocardiogram

Chest X Ray

  • Bone x-rays

CT

MRI

Echocardiography or Ultrasound

Other Imaging Findings

  • Bone density test (DXA)

Other Diagnostic Studies

Treatment

Pharmacotherapy

Acute Pharmacotherapies

Chronic Pharmacotherapies

Surgery

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

Indications for Surgery

Pre-Operative Assessment

Post-Operative Management

Transplantation

Primary Prevention

Secondary Prevention

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

Cost-Effectiveness of Therapy

Future or Investigational Therapies

References

  1. Parathyroid hyperplasia. Librepathology (2016). http://librepathology.org/wiki/index.php?title=Parathyroid_hyperplasia&redirect=no Accessed on January 7, 2016