Diagnosis of Hyperparathyroidism

Abstract

States of hypersecretion of PTH may occur primarily, or in response to other physiologic abnormalities. Primary hyperparathyroidism must be considered in the differential diagnosis of hypercalcemia, nephrolithiasis, metabolic bone disease, and pancreatitis and peptic-ulcer disease. The clinical manifestations of this disease have become more subtle with improved detection. The serum calcium level is almost always elevated, and when it it accompanied by relatively high serum PTH levels or increased urinary cAMP excretion, the diagnosis is usually secure. Findings of hypophosphatemia, decreased renal tubular reabsorption of phosphorus, hypercalciuria, and characteristic roentgenographic changes support the diagnosis of hyperparathyroidism, but are not prerequisites for that diagnosis. Most cases will come to operation, and experienced intraoperative assessment is necessary for the correct distinction between multiglandular disease and that involving only a single gland. We expect that a clearer understanding of the histopathologic features of these diseases, and improvement in the methods for measurement of PTH will be the main areas of advancement in the diagnosis of hyperparathyroidism in the next few years.

Nonpharmacological approaches to the control of high blood pressure. Final report of the Subcommittee on Nonpharmacological Therapy of the 1984 Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure.

“…This concept of selective response to calcium supplementation was noted in a study by Resnick et al' l5 Although neither randomized nor placebo controlled, the study indicated that hypertensive patients who were most likely to respond to orally administered calcium supplementation are those with low serum ionized calcium levels and low plasma renin activity. To confuse matters, however, other studies have suggested that 1) a direct relationship exists between serum calcium concentration and blood pressure," 6 "" 8 2) hypercalcemic states," 9 including hyperparafhyroidism, 120 have been associated with hypertension, and 3) induced hypercalcemia raises blood pressure in normotensive subjects. 121 In addition to the epidemiological and clinical data, a few studies have assessed the effects of supplementary dietary calcium on blood pressure in experimental animals.…”