1. PARATHYROID Disorders
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2. PARATHYROID GLANDS

3. Anatomy
Soft, yellow-brown, oval glands. Each weighs 30-50mg, measures 6x3x3mm. Usually 4 in number, about 10% of people have 1or more supernumerary glands and some have fewer than 4
Superior PT gland arises from the 4th pharyngeal pouch. Position is fairly constant in close proximity to d post. portion of the upper thyroid poles.
Inferior PT glands arise from the 3rd pharyngeal pouch wt the thymus. Ectopic sites are more common.
Arterial supply is by branches of inferior thyroid aa
Histologically contains chief cells predominantly and oxyphil cells.
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4. Ectopic sites
Superior position: post to inferior thyroid artery, retro-oesophageal, retro-pharyngeal or intrathyroidal
Inferior Position: high in the neck at level of hyoid bone, or low within the thymus in the superior mediastinum.

5. Functions
Secrete parathyroid hormone (PTH) which regulates the level of calcium in the blood.
BONE: se osteoclast and osteoclast activity,
 Ca and PO4 absorptn fm bone.
KIDNEY: se distal tubular Ca reabsorption and
↓proximal tubular reabsorption of PO4.
Promotes 1α hydroxylation of 25(OH)D2 thereby enhancing absorption of Ca from the gut.
Stimulates synthesis of Vit D viz  GI absorption of Ca.
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6. PRIMARY HYPERPARATHYROIDISM
A sporadic or familial disorder assd wt hpercalcaemia, elevated PTH levels and PT gland enlargement.
Incidence: sporadic in 1% of adults, women > men,  with age. Familial occurs as part of MEN Type 1, MEN Type2 or familial isolated hyperparathyroidism.
Aetiology: Adenoma 85%, Hyperplasia 14% and carcinoma 1%
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7. Clinical features Asymptomatic CVS Hypertension MUSCULOSKELETAL
Bone, muscle, joint pain
Weakness
Osteopaenia
Osteitis fibrosa cystica
Pathological fracture
GIT
Peptic ulcer Nausea
Constipation Vomiting
Pancreatitis
RENAL
Nephrocalcinosis Polyuria
Urinary tract calculi Nocturia
CVS
Hypertension
LV hypertrophy
Heart block
NEUROLOGIC
Headache Neurosis
Dementia Psychosis
METABOLIC
Hyperuricaemia
Peripheral insulin resistance
Lipid abN

8. Diagnosis Biochemical Plasma Ca, ↓PO4 Urinary PO4 and Ca = 
 plasma alkaline phosphatase
PTH levels
E/U= Cl, ↓HCO3
Modified Chlorine phosphate ratio
Imaging
Radiological- BONES: subperiosteal resorption, rarefaction, loss of lamina dura, bone cyst. ABD: renal stones, calcification of pancreas.
USS, CT Scan, MRI to localize the PT gland
Technetium 99 scan

9. DIFFERENTIAL DIAGNOSIS
Hypercalcaemia of malignancy
Multiple myeloma
Thiazide diuretics
Vit D excess
Hyperthyroidism
Immobilisation
Milk-alkali syndrome
Sarcoidosis
phaeochromocytoma
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10. Treatment
Medical
Oestrogen supplements or biphosphonate therapy to lowere serum Ca
General measures include adequate hydration, avoid xss Ca intake, cessation of thiazide diuretics
Hypercalcaemia crises- acute symptoms requiring urgent treatment. Ca >3.5mmol/L. Symptoms include irritability, severe weakness, prostration, nausea, vomiting wt dehydration,
Rehydartion 8L N/S .Cortisone mg
Forced diuresis, Frusemide mg dly
Iv diphosphonate therapy haemodialysis
Mithramycin 25microgram per kg

11. Surgical Treatment Indications for parathyroidectomy
Urinary tract calculi
Markedly reduced bone density
Serum calcium >2.85mmol/L
Severe symptoms
Post op care
check for signs of hypoPTH 1/2hrly, determine the serum Ca levels on evening of operation and next morning. Levels should fall within 24-48hrs. Levels <1.6mmol/L, give 20ml of 10% calcium gluconate and oral supplements of Ca 3-5mg tds

12. HYPOPARATHYROIDISM Deficiency of PTH Aetiology Congenital
DiGeorge’s syndrome
Acquired
Post operative (thyroidectomy, compromised blood supply during thyroidectomy, parathyroidectomy)
Haemachromatosis
Wilson’s dx
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13. Clinical features Symptoms of hypocalcaemia
Perioral numbness and tingling,Paraesthesia of fingers and toes. In severe cases, Muscle cramps, irritability, convulsion, laryngeal spasms, carpopedal spasms,ventricular arrythmia. Late complications include personality changes,cataract,
Chvostek’s sigm
Trosseau’s sign
ECG changes – prolonged QT interval and QRS changes
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14. Diagnosis Low serum Ca  serum Phosphate Low urine phosphate
Normal alkaline phosphate
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15. Treatment A medical emergency requiring urgent attention
10ml iv Ca gluconate or Ca chloride initially followed by oral tablets + Vit D.
Maintenance:
High Calcium low phosphate diet
Calcium supplements
Vit D or cholecalciferol.
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16. THANK YOU
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