2. Parathyroid Hyperplasia( %10 ) Parathyroid Carcinoma < %1
Hyperparathyroidism
Primary Hyperparathyroidism
Single Adenoma( %85 )
Multiple Adenoma(%5 )
Parathyroid Hyperplasia( %10 )
Parathyroid Carcinoma < %1

3. Parathyroid Hyperplasia( %10 ) Parathyroid Carcinoma < %1
Hyperparathyroidism
Primary Hyperparathyroidism
Single Adenoma( %85 )
Multiple Adenoma(%5 )
Parathyroid Hyperplasia( %10 )
Parathyroid Carcinoma < %1

4. Secondary to Hypocalcemia Renal Calcium Leak
Hyperparathyroidism
Secondary Hyperparathyroidism
Tertiary Hyperparathyroidism
Secondary to Hypocalcemia
Renal Calcium Leak
Dietary Calcium Malabsorption
Vit D deficiency

7. Parathroid Adenoma

10. CLINICAL MANIFESTATION
50-80% asymptomatic
GI : loss of apetite,vometing, abdominal pain , constipation ,pancreatitis
Central nervous system: lethargy, drowsiness coma , hyporeflexia
Neuromuscular :easy fatigability, proximal weakness, muscle atrophy, paresthesia , carpal tunnel
Cardiac : HTN, arrythmias, CHF
Kidney :
Nephrolithiasis (calcium oxalate and calcium phosphate )may lead to infection and loss of renal function :
Nephrocalcinosis may decreased renal function

11. Rheumatologic Manifestation
Of Hyperparthyroidism
Osteitis Fibrosa Cystica
Osteoporosis
Erosive Arthritis
Chondrocalcinosis
Ectopic Calcification
Subchondral Fracture
Myopathy
Joint Laxity
CTS
Richets ( child )

12. Osteitis Fibrosa Cystica
Most Specific pathologic Finding
Number of Trabecula
Giant Multinuclear Osteoclast
Replacement of BM with Fibrosis
Radiology :
Bone Cyst ( Brown tumor )
Pepper + Salt
Subperiosteal Resorption

13. PATHOLOGY Decreased number of trabecula Giant multinuclear osteoclast
Replaced bone marrow with fibrosis

14. Osteoclast reabsorption

16. Normal skull

17. Salt and pepper in Skull

18. SALT AND PEPPER

21. Distal Clavicular Resorption

22. SUBPERIOSTEAL RESORPTION
In radial aspect of figers (2,3)

24. Subperiosteal Resorption

26. Phalanx resorption

27. Brown Tumor

28. BROWN TUMOR

29. Brown Tumor

30. Brown Tumor

31. Brown Tumor ( Histology)

33. Normal sacroiliac joint

34. Normal sacroiliac

35. Pseudowidening of Sacroiliac Joints

36. Soft tissue calcification( Hyperpara)

37. Soft tissue calcification

38. Normal lumbosacral

39. Osteoporosis

41. BONE CYST

42. Chondocalcinosis

43. Raggerr gersy
Secondary
Hyperparathyroidism

45. Laboratory : Imaging : Detection of Primary hypepara
Ca , P , Alk Ph , PTH
High Frequency Ultrasound
TC99 Pertechnetate + Thalium
TC99 Sestamibi Scanning
Cervical MRI Scanning
Intravenous Digital Subtraction
Angiography

47. 2- Medical Estrogen Calcitonin Biphosphonate Others
Treatment of Primary Hyperpara
2- Medical
Estrogen
Calcitonin
Biphosphonate
Others

48. 1- Surgical : Treatment of Primary Hyperpara age < 50 y
ca > 1/ 6 mg / 100 ( upper limit )
age matched Clcr > %30
History of Lifethreatening Ca
24 h urinary Ca > 400 mg
Z Score < -2 SD