DIAGNOSIS OF

HYPERPARATHYROIDISM
Deeksha Kamath
23
Biochemical investigation

Estimation of fasting serum calcium and phosphate.

◦ Hypercalcemia and hypophosphatemia with
detectable or elevated PTH are hallmark of
hyperparathyroidism

◦ Renal function tests.

◦ Establish hypercalcemia in more than one serum
measurement accompanied by elevated
immunoreactive PTH is characteristic.

◦ Correction of serum calcium: Calcium level is

corrected for low albumin levels by adding 0.8 mg/dL
to the total serum calcium level for every 1.0g/dL to
which the serum albumin concentration is lower than 4
g/dL.
◦
May be associated with mild hyperchloremic acidosis.
Urine investigations
◦ Hypercalciuria (>300 mg/24 hours) Observed in
30% of the patients.

◦ Increased markers of bone resorption: These include

urinary pyridinoline, deoxypyridinoline and N-
telopeptide of collagen.
ECG findings
◦ Shortened QT interval.
Rarely cardiac arrhythmias.
 Radiological abnormalities
Most sensitive and specific
radiologic finding of Osteitis
fibrosa cystica is subperiosteal
resorption of cortical bone best
seen in high resolution films of
the phalanges.
A similar process in
the skull leads to a
salt-and-pepper
appearance of skull.
◦ Bone cysts or brown tumours may be evident as osteolytic lesion.

◦ The other important skeletal consequence of hyperparathyroidism is

Osteoporosis. Unlike other osteoporotic disorders,
hyperparathyroidism often results in the preferential loss of cortical
bone.
◦
Dental films may disclose loss of the lamina dura of the teeth, but this
is a nonspecific finding also seen In periodontal disease.
◦ Nephrocalcinosis: Appear as scattered opacities
within the renal outline.

◦ Soft tissue calcification: For example, calcification

of arterial wall.
◦
Dual-energy X-ray absorptiometry (DEXA) and
CT scan:
Reveal reduced bone density.
 Investigations for localization of the tumour:

Parathyroid imaging is generally indicated only for patients

who have undergone previous parathyroid surgery.
Investigations to localize the tumor include:
◦ High-resolution ultrasonography,
◦ CT scanning and subtraction imaging and scintigraphy with
technetium 99 sestamibi.
◦ Selective neck vein catheterization with PTH estimation.
 Tc-sestamibi scan of a patient with primary hyperparathyroidism secondary to a
parathyroid adenoma. A- After 1 hour, there is uptake in the thyroid gland (thick
arrow) and the enlarged left inferior parathyroid gland (thin arrow).
B-After 3 hours, uptake is evident only in the parathyroid (thin arrow).