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Parathyroid hormone increases the release of calcium and phosphate from bone,
increases calcium reabsorption by the kidney and increases renal production of 1,25-
dihydroxyvitamin D-3 (calcitriol) which increases intestinal absorption of calcium. As well
as increasing serum calcium, parathyroid hormone also causes phosphaturia, therefore
reducing serum phosphate levels.
Epidemiology
pancreatitis
o Polyuria, polydipsia, dehydration
o Neuropsychiatric manifestations are particularly common and may include
Total serum calcium and albumin levels; ionized calcium levels if available.
Renal function, electrolytes, amylase.
24 hour urinary calcium excretion: to differentiate from familial hypocalciuric
hypercalcaemia in which there is a low 24 hour urine calcium excretion. May not
be necessary if the diagnosis of primary hyperparathyroidism is not in doubt.
X-rays: is occasionally helpful to determine end organ damage (but likely to be
normal in early cases). Subperiosteal resorption (especially on hand x-ray); chest
x-ray and skull x-ray (pepper-pot skull). Consider x-ray's of other joints
(chondrocalcinosis, pseudogout).
DEXA scan: osteoporosis is common.
Imaging of renal tract: x-ray, ultrasound.
If neck exploration has failed, 99mTc-sestamibi scan, Thallium or Tc subtraction
scanning, CT scan, ultrasound, and/or angiography with selective venous
sampling may be required.