2.  Renal tubules
Increases reabsorption of calcium
Increases phosphate excretion by restricting
its reabsorption
 Bone
Promotes osteoclastic resorption and release of
calcium and phosphate into blood

3.  Intestine
Stimulates calcium absorption by promoting the
conversion of vitamin D to its active metabolite in the
kidney

4.  Primary – Adenoma, Hyperplasia or carcinoma
 Secondary – In renal diseae
 Tertiary – When secondary hyperplasia leads to
autonomous overactivity

5.  Pathology
 Hypercalcemia
 Hypercalciuria
 Hyperphosphoturia
 Kidney:Calcinosis,stone formation,recurrent
infection and impaired function

6.  General loss of bone substance
 Subperiosteal erosion
 Endosteal cavitation
 Osteitis fibrosa cystica :Replacement of
marrow spaces by vascular granulations and
fibrous tissue
 Brown tumor:Haemorrhage and giant cell
reaction within fibrous stroma gives rise to
brownish tumor like masses, whose liquefaction
leads to fluid filled cysts

7.  Middle aged(40-65 years)
 Women are affected twice as often as men
 Many remain asymptomatic
 Stones,Bones,Groans
 Anorexia,nausea,abdominal
pain,depression,fatigue and muscle
weakness
 Polyuria,kidney stones
 Joint symptoms due to chondrocalcinosis

8. • Osteoporosis
• Subperiosteal cortical resorption of middle phalanges
• Vertebral collapse
• Brown tumors
• Renal calculi,Nephrocalcinosis
• Chondrocalcinosis

17.  Hypercalcemia
 Hypophosphataemia
 Raised PTH
 Raised serum alkaline phosphatase

18.  Phosphate excretion test
 Phosphorous loading
 Dietary Phosphorous and Calcium deprivation
 Urinary hydroxyproline
 Cortisone suppression
 Radioisotpe subtraction scanning

19.  Exclusion of other causes of hypercalcemia like
multiple myeloma,metastatic
disease,sarcoidosis in which PTH levels are
usually are depressed
 All types of osteoporosis and osteomalacia

20.  Adequate hydration
 Phosphate ingestion
 Decreased calcium intake
 Parathyroidectomy: Indications
◦ Marked and unremitting hypercalcemia
◦ Recurrent renal calculi
◦ Progressive nephrocalcinosis
◦ Severe osteoporosis

21. Postoperative severe hypocalcemia due to brisk formation
of new bone
Must be treated promptly with fast acting vit D
metabolites

22.  Seen in Renal rickets and Reanl osteomalacia
 Treatment is directed at primary condition

23.  < 10 %
 Fracture neck of femur is common
 Fracture line is usually vertical at the base of the
neck with preexistent coxa vara
 Young patients-Valgus osteotomy
 Elderly patients-Primary arthroplasty

24.  Accidental removal of parathyroids during
thyroidectomy
 Low serum Calcium and high serum phosphorous
 Signs of neuromuscular excitation
 PTH/Dihydrotachysterol
 Diet high in calcium
Milk is contraindicated due to its high phosphrous
 Infusions of Magnesium sulfate restore the serum
calcium levels to normal

25.  Congenital lack of adenyl cyclase
 Production of PTH is adequate
 Target organs do not respond to the hormone
 Urinary excretion of cyclic AMP reduced
 Dehydrotachysterol/Vit D2