Internal Medicine

0521779407-17 CUNY1086/Karliner 0 521 77940 7 June 13, 2007 7:57

1212 Primary Hyperparathyroidism

■Osteoporosis, fractures

■Psychological complaints – depression, fatigue

■May occur in MEN 1 (common, penetrance >90%), MEN 2A (up to

50%), MEN 2B (10%)

Signs & Symptoms

■Height loss due to osteoporosis

■Band keratopathy

■Flank pain secondary to renal colic

■50–70% patients asymptomatic

■Wide spectrum of symptoms

■CNS: decreased memory and concentration, lethargy, depression,

somnolence

■Cardiovascular: hypertension

■Neuromuscular: myopathy

■Musculoskeletal: aches and pains, arthralgias, fractures, osteitis

fibrosa cystica (rare)

■Gastrointestinal: anorexia, constipation, pancreatitis, peptic ulcer

■Renal: dehydration, thirst, polyuria, renal stones

tests

Laboratory

■Blood:

➣elevated total Ca (occasionally ionized Ca needed)

➣elevated or high normal intact PTH (90% of patients above nor-

mal)

➣low or normal serum P

➣elevated alk phos, if advanced skeletal disease

➣high or normal 1,25-OH-vitamin D

■Urine:

➣24 h Ca (>100 mg)

➣Ca/creatinine clearance (>0.01): U-Ca X S-creat/S-Ca X U-creat

Screening

■Asymptomatic elevated Ca on routine chemistry

Confirmatory Tests

■Elevated Ca

■Inappropriately normal or frankly elevated PTH

■Elevated Ca/creat clearance