Parathyroid disease
Description
Hyperparathyroidism
| Ca | PO4 | PTH | Setting | |
|---|---|---|---|---|
| Primary | inc | dec | inc or inappropriately normal | Autonomous adenoma/hyperplasia |
| Secondary | dec or low-normal | inc (CKD) / dec (vit D def) | inc | Appropriate response to hypocalcaemia |
| Tertiary | inc | inc | inc | Autonomous gland after long-standing secondary |
- Normocalcaemic PHPT - normal albumin-corrected AND ionised Ca, raised PTH, all secondary causes excluded
Hypoparathyroidism
- Ca dec, PO4 inc, PTH low or inappropriately normal
- Pseudohypoparathyroidism = PTH resistance -> same biochemistry but PTH high
- Type 1a (Albright hereditary osteodystrophy): GNAS, short 4th/5th metacarpals, round face, short stature, obesity, +/- TSH and gonadotrophin resistance
- Magnesium is the great mimic: hypoMg causes both PTH deficiency and PTH resistance - and neither corrects until Mg is replaced
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