1 PI24 ENDOCRINOLOGA Paratiroides Hiperparatiroidismo y Hipoparatiroidismo

Calcium Pathology in Nephrology

Overview of Calcium Disorders

• Discussion begins on calcium pathology, particularly focusing on nephrology and the significance of primary hyperparathyroidism as a major cause.

Hyperparathyroidism Insights

• Primary hyperparathyroidism is identified as the most important cause of mild to moderate hypercalcemia, contrasting with severe cases often linked to neoplastic conditions.

• Symptoms associated with primary hyperparathyroidism include kidney stones (litiasis), increased urinary calcium (hypercalciuria), and peptic ulcers due to elevated acid secretion.

Differentiating Types of Hyperparathyroidism

• The distinction between primary and secondary hyperparathyroidism is emphasized; secondary typically results in hypocalcemia, often due to chronic kidney disease or vitamin D deficiency.

• In primary cases, treatment usually involves surgical removal of adenomas causing excess parathormone production, leading to hypercalcemia and hypercalciuria.

Management Strategies

• Medical management for primary hyperparathyroidism may involve calcimimetics that enhance receptor sensitivity to reduce parathormone secretion.

• Secondary hyperparathyroidism management focuses on correcting underlying hypocalcemia while addressing issues like hyperphosphatemia through medications such as calcitriol.

Hypoparathyroidism: Causes and Effects

Understanding Hypoparathyroidism

• The discussion transitions to hypoparathyroidism, highlighting post-surgical causes (e.g., thyroid surgery) as the most common reason for acute hypocalcemia.

Clinical Manifestations

• Acute hypoparathyroidism can lead to tetany, while chronic cases may result in extrapyramidal disorders, cataracts, and basal ganglia calcifications.

Treatment Approaches

• Treatment primarily involves calcium supplementation along with vitamin D. Post-surgical complications are noted as significant contributors to both hypocalcemia and hypoparathyroidism.

Rare Causes of Hypoparathyroidism

• Other less common causes include autoimmune conditions affecting parathyroid glands and granulomatous diseases like sarcoidosis.

Post-Surgical Complications: Bone Hunger Syndrome

Bone Hunger Syndrome Explained

• The "hungry bone syndrome" occurs after paratiroidectomy when bones rapidly absorb available calcium due to loss of parathormone stimulation. This can lead to severe acute symptoms including tetany or convulsions following surgery.