Reumatología Clínica (English Edition) Reumatología Clínica (English Edition)
Reumatol Clin 2012;8:287-91 - Vol. 8 Num.5 DOI: 10.1016/j.reumae.2011.06.002
Continuing Medical Education
Hyperparathiroidism: Primary or Secondary Disease?
Hiperparatiroidismo: ¿primario o secundario?
Isabel Martínez Cordellat
Servicio de Reumatología, Hospital Universitario Doctor Peset, Valencia, Spain
Received 06 May 2011, Accepted 17 June 2011
Abstract

Primary hyperparathyroidism (PHPT) is characterized by the autonomous production of parathyroid hormone (PTH), in which there is hypercalcemia or normal-high serum calcium levels in the presence of elevated or inappropriately normal serum PTH concentrations.

Exceptionally in symptomatic patients, a diagnosis can be established on the basis of clinical data. PHPT must always be evaluated in patients with clinical histories of nephrolithiasis, nephrocalcinosis, osseous pain, subperiosteal resorption, and pathologic fractures, as well as in those with osteoporosis–osteopenia, a personal history of neck irradiation, or a family history of multiple endocrine neoplasia syndrome (types 1 or 2).

Diagnosis of PHPT is biochemical. Asymptomatic hypercalcemia without guiding signs or symptoms is the most frequent manifestation of the disease. For differential diagnosis, PTH must be measured, as well as phosphate, chloride, 25-hydroxyvitamin D, 1,25 dyhidroxyvitamin D and calcium-to-creatinine clearance.

The diagnosis and differential diagnosis of primary hyperparathyroidism will be discussed here.

Resumen

El hiperparatiroidismo primario (HP) es una entidad clínica que se caracteriza por la producción autónoma de parathormona (PTH), en la cual hay hipercalcemia o calcio sérico normal-alto, con valores de PTH elevados o inapropiadamente normales.

De forma excepcional, el diagnóstico puede establecerse a partir de la clínica en pacientes sintomáticos. El HP siempre debe ser tenido en cuenta en pacientes con historia de cálculos renales, nefrocalcinosis, dolor óseo, fracturas patológicas, resorción subperióstica o en aquéllos que presenten osteoporosis-osteopenia, antecedentes de irradiación en cuello o historia familiar de neoplasia endocrina múltiple tipo 1 o 2.

El diagnóstico del HP es bioquímico, siendo la hipercalcemia asintomática la manifestación más frecuente de la enfermedad. Para el diagnóstico diferencial, además de la PTH, debe medirse el fósforo, cloro, 25 hidroxivitamina D, 1,25 dihidroxivitamina D y calciuria.A continuación, se revisa el diagnóstico y se detallan los cuadros clínicos con los que se debería plantear el diagnóstico diferencial.

Keywords
Primary hyperparathyroidism, Secondary hyperparathyroidism, Hypercalcemia, Familial hypocalciuria hypercalcemia, 25-hydroxy vitamin D, 1,25-dihydroxy vitamin D, Osteoporosis, Osteopenia
Palabras clave
Hiperparatiroidismo primario, Hiperparatiroidismo secundario, Hipercalcemia, Hipercalcemia hipocalciúrica familiar, 25-hidroxivitamina D, 1,25-dihidroxivitamina D, Osteoporosis, Osteopenia

Article

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Reumatol Clin 2012;8:287-91 - Vol. 8 Num.5 DOI: 10.1016/j.reumae.2011.06.002