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Hypercalcaemia

  • Parathyroid glands derived from pharyngeal pouches
  • Pouch III - Inferior parathyroid glands
  • Pouch IV - Superior parathyroid glands
  • Abnormalities of position and number of glands common
  • 5% of population have less than four glands
  • 25% have supernumerary glands often in aberrant positions (e.g. thymus)

Pharyngeal embryology

Parathyroid physiology

  • Parathyroid hormone is an  84 amino-acid protein (MW = 9500)
  • Has half life measured in minutes
  • Broken down to C and N terminal fragments which remain biologically active
  • Acts on cell membrane receptors increasing cAMP
  • In bone - increases turnover and Ca release
  • In kidney - increases production of 1,25 dihydroxy -Vitamin D3
  • In gut - increases Ca absorption

Causes of hypercalcaemia

  • Primary hyperparathyroidism
  • Malignancy
  • Granulomatous disease
    • Sarcoidosis
    • Tuberculosis
  • Drugs
    • Thiazide diuretics
    • Vitamin D toxicity
    • Lithium
    • Milk alkali syndrome
  • Familial hypercalciuric hypercalcaemia
  • Endocrine
    • Thyrotoxicosis
    • Adrenal crisis
  • Immobilisation
  • Renal Failure
  • Aluminum intoxication

Bibliography

Roche N A,  Young A E.  The role of surgery in mild hyperparathyroidism in the elderly.  Br J Surg 2000;  87:  1640-1649.
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