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Vol. 8. Issue 5.
Pages 287-291 (September - October 2012)
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Vol. 8. Issue 5.
Pages 287-291 (September - October 2012)
Continuing Medical Education
DOI: 10.1016/j.reumae.2011.06.002
Hyperparathiroidism: Primary or Secondary Disease?
Hiperparatiroidismo: ¿primario o secundario?
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Isabel Martínez Cordellat
Servicio de Reumatología, Hospital Universitario Doctor Peset, Valencia, Spain
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Figures (2)
Tables (4)
Table 1. HP Differential Diagnosis/Malignant Disease.
Table 2. HP Differential Diagnosis/HHF.
Table 3. Causes of Secondary Hyperparathyroidism.
Table 4. Normocalcemic HP/HP With Vitamin D Deficiency/HS Due to Hypovitaminosis D.
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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.

Keywords:
Primary hyperparathyroidism
Secondary hyperparathyroidism
Hypercalcemia
Familial hypocalciuria hypercalcemia
25-hydroxy vitamin D
1,25-dihydroxy vitamin D
Osteoporosis
Osteopenia
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.

Palabras clave:
Hiperparatiroidismo primario
Hiperparatiroidismo secundario
Hipercalcemia
Hipercalcemia hipocalciúrica familiar
25-hidroxivitamina D
1,25-dihidroxivitamina D
Osteoporosis
Osteopenia

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