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Hyperparathyroidism

Primary hyperparathyroidism

Hyperparathyroidism can occur at any age, both men and women, more often in postmenopausal women. Usually associated with adenoma of one of the parathyroid glands, less often – with hyperplasia of the glands and even more rarely – with carcinoma.

Hyperparathyroidism detected in the first direct measurement of parathyroid hormone (PTH) in blood serum. In addition, to characterize the metabolic changes recommended to investigate the renal clearance of phosphate.

In patients with hyperparathyroidism increased risk of osteoporosis and the development of urolithiasis.

Secondary and tertiary hyperparathyroidism

The concentration of parathyroid hormone (PTH) increases in the plasma of patients with chronic renal insufficiency and deficiency of vitamin D. In both cases, there is a decrease of synthesis in the kidneys of the active form of vitamin D3 – 1,25 (OH) D3 (calcitriol), which is the cause of hypocalcemia and increased PTH secretion. This reaction is the basis of secondary hyperparathyroidism.

Lumbosacral spine radiograph reveal radiological appearances of secondary hyperparathyroidism ("rugger jersey spine") – alternating bands of sclerosis and lucency throughout the lumbar spine in patient with renal failure.
CT imagine of multiple tiny well defined lucencies in the skull vault caused by resorption of trabecular bone in hyperparathyroidism ("Salt and pepper" sign or "pepperpot skull" of the calvarium).

At the same time in patients with end-stage of renal failure often occurs hypercalcemia, which develops due to autonomous secretion of PTH, particularly if it was preceded by hypocalcemia.

Same hypercalcemia may at first maintained in patients after kidney transplantation, which normalizes the ability to metabolize vitamin D. This condition has been called tertiary hyperparathyroidism.