Diseases of the parathyroid glands

Dr Junaid Shaik
Diagnostics IB
 Role of the parathyroid hormone
Parathyroid hormone regulates serum calcium through
its effects on bone, kidney, and the intestine

PTH enhances release of Ca2+ from the bones

PTH binds to osteoblasts (responsible for laying down

bone) = increased expression of RANKL (TNF-α ligand)
and inhibits secretion of osteoprotegerin (OSP)

Free OSP binds to RANKL = preventing it from binding

with RANK. But the binding of RANKL to RANK stimulates
osteoclasts precursors = differentiate to osteoclasts =
mediate bone resorption = release of Ca2+ from bone to
blood

In the kidney, PTH prevents reabsorption of HPO42− from

the tubular fluid = decrease in plasma phosphate
concentration
Stimulates conversion of 25-hydroxy vitamin D to 1,25-
dihydroxy vitamin D = stimulates Ca2+ uptake from the
intestine
 Hyperparathyroidism Treatment:
Surgery (parathyroidectomy)
For secondary HPT: active
vitamin D; treatment of
Causes: kidney disease
Parathyroid adenoma Clinical features:
(most common cause) (features of hypercalcaemia)
Parathyroid hyperplasia
Parathyroid Ca
“Stones”: kidney stones
Secondary HPT: excess PTH
“Bones”: bone pain,
produced in response to pathological fractures
low Ca2+ in the blood = “Groans”: abdominal pain
hyperplasia of the (peptic ulcers and pancreatitis)
parathyroid glands “Thrones”: constipation and
Chronic kidney disease is polyuria (diabetes insipidus)
the most common cause;
other causes include
Other: memory loss, fatigue,
malabsorption syndromes
depression, proximal muscle
weakness, LV hypertrophy

Serum calcium Phosphate ALP PTH Likely type

↑ ↓
↓ ↑
Primary
↑ ↑
hyperparathyroidism
Secondary
↑ ↑
hyperparathyroidism
 Hypoparathyroidism Serum calcium
↓
Phosphate
↑
PTH
↓

Causes: Clinical features:

Thyroidectomy (which
includes removal of the PT
glands)
Haemochromatosis (excess
Fe causes dysfunction of the
PT glands)
Autoimmune destruction of
the PT glands
Magnesium deficiency (Mg
is required for PTH secretion)
Low serum Ca2+ levels
interfere with muscle
contraction and nerve
conduction
Uncomfortable tingling
(parasthaesia) around
the mouth, hands and
feet
Severe muscle cramps
and spasms (tetany)
Cramping abdominal
pain
Cardiac arrhythmias
Chvostek’s sign
Trousseau's sign

Treatment: IV calcium e.g. calcium gluconate

 How to study for this section?
 Know the production of hormones and functions of the parathyroid glands
 Know the musculoskeletal manifestations of parathyroid gland and
hormone disease
 Know what tests (laboratory and radiographic) to order and how to
interpret these
 As a chiropractor, why would you need to have a good understanding of
parathyroid disorders
 You may view the following video on HPT disease:
https://www.youtube.com/watch?v=UmXHhsPwGP0&t=101s