What Causes Hyperparathyroidism?

Posted on Tue, 31 Mar 2015

Medically reviewed by Ask A Doctor - 24x7 Medical Review Team

Tue, 31 Mar 2015 Answered on

Mon, 20 Apr 2015 Last reviewed on

Question : I am frustrated with trying to get a dx with regard to an abnormally high PTH. What is the best imaging test to make a determination. My calcium runs low normal. But PTH is 248.3. Also I have 3 autoimmune diseases; RA, Sjogrens, Fibromyalgia, plus steatohepatitis, osteoporosis, chronic pain syndrome, gastrophoresis and degenerative disc disease and some other dx.

What imaging test should be ordered to confirm: primary or secondary hyperparathyroidism.

Answered by Dr. Ajish TP (1 hour later)

Brief Answer:
Please do vitamin D and kidney function

Detailed Answer:
Hi,

Welcome to HCM. I have gone through the question and understand your concerns.

In primary Hyperparathyroidism the calcium is usually on higher side ( not lower). So if your calcium is on the lower side it is most probably secondary Hyperparathyroidism. We should go for imaging only after confirmation of type of Hyperparathyroidism.

The test you should do are

1. Fasting calcium, phosphorus and albumin.
2. serum 25 hydroxy vitamin D and renal function test
3. 24 hours urine calcium : creatinine ratio.
4. X ray of left hand to see any bony abnormalities

In primary Hyperparathyroidism:

Calcium high, phosphorus low, urine calcium creatinine ratio high, X-ray show bony changes and kidney function is usually normal.

In secondary Hyperparathyroidism:

Calcium low, phosphorus low or high, creatinine high or vitamin D low, urine calcium low

So based on these test we confirm the type.

Imaging usually we do are ultrasound neck and functional imaging ( MIBI scan).

Hope I have answered your questions. If you have any further queries I will be happy to help you.

Regards,

Dr Ajish TP [MD,DM]
Consultant Endocrinologist

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Ajish TP (11 hours later)

I appreciate this input.
Fasting calcium. 8.8. 8.5-10.5
Alk Phos. 93.0. N 38.0-110
24 hr urine. 8
GFR 60.3
Creatinine 1.00. N 0.60-1.2

If this is secondary hyperparathyroidism, what is the treatment option?

Answered by Dr. Ajish TP (42 minutes later)

Brief Answer:
please do a serum fasting phosphorus & vitamin D

Detailed Answer:
Hi,

Welcome back.

Please do a serum phosphorus and 25 hydroxy vitamin D. These reports are more in favour of secondary Hyperparathyroidism - most probably secondary to vitamin D deficiency. If vitamin D levels are low, we can first correct it over 2 months and recheck calcium, phosphorus and albumin after that. This will give a clear picture.

Regards
Dr Ajish TP

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar