Endocrine Abstracts

The sustained over-secretion of PTH is a common clinical problem with particular consequences for the skeleton. Hyperparathyroidism (HPT) increases the bone surface undergoing remodelling, amplifies the negative balance at the bone multicellular unit and increases activation frequency, eroded surface and formation, without increased trabecular perforation. Cortical bone is particularly susceptible to the effects of hyperparathyroidism and bone mineral density (BMD) measurement...

Secondary hyperparathyroidism, an inevitable consequence of untreated chronic uraemia, is an adaptive response to sustained phosphate retention, failure of calcitriol synthesis and hypocalcaemia. For many years the therapeutic approach to these abnormalities has been relatively constant, comprising, respectively, dietary phosphate restriction with oral phosphate binders, replacement of the deficient active vitamin D ligand, and calcium supplementation by the oral and/or transd...

PHP has four serious complications: urinary calcium stone disease; nephrocalcinosis; high-turnover metabolic bone disease; and hypercalcemia. Medical management is reserved for patients who are asymptomatic or who have failed, refused or are unfit for surgery. Aims of medical management are to prevent increase in severity of disease and to ameliorate and prevent the disease complications.Prevention of increase in severity includes regular follow-up, ensu...

The gold standard for the surgical cure of primary hyperparathyroidism (PHPT) for many years was cervical exploration under general anaesthetic, identification of 4 parathyroid glands and removal of enlarged/abnormal glands. Despite cure rates in expert hands of 98% with minimal morbidity the surgical management of PHPT is changing.PHPT in most cases (85%) is caused by single gland disease. The advances in preoperative localisation of abnormal parathyroi...