Dr Kevin McCarroll BA. MD. MRCPI.
Consultant Physician & Geriatrician, Bone Health Unit
St James's Hospital, Dublin
Presentation Title: Hyperparathyroidism – An Up To Date Review
Hyperparathyroidism is a common condition that causes bone loss at cortical sites such as the hip and forearm and results in increased fracture risk. Secondary hyperparathyroidism usually results from low vitamin D status and /or inadequate calcium intake. It affects about 30% of vitamin D deficient adults and is more common in Winter. It may cause osteomalacia (characterised by elevated PTH & ALP and low or low normal serum calcium).
Primary hyperparathyroidism occurs in up to 1% of adults aged over 50 withh the majority of patients having no overt symptoms. In most cases, it results in hypercalcaemia, low normal phosphate, elevated PTH and hypercalciuria. About 20% have hypercalcaemia with a normal but non-suppressed PTH. A small proportion of patients have ‘normocalcaemic primary hyperpathyroidism’ where serum calcium is normal but PTH is elevated.
Primary hyperparathyroidism is biochemical diagnosis and imaging is only required to localise the affected glands in patients who are candidates for surgery. Recent guidelines (5th International workshop on Evaluation & Management of Primary Hyperparathyroidism, 2022) outline clinical indications for surgery. Solitary parathyroid adenomas (80-90% of cases) that are located on imaging can be removed with Minimally Invasive Parathyroidectomy (MIP) which is associated with improvement in bone mineral density.
For patients not suitable for surgery, cinacalcet may be used to lower serum calcium and bisphosphonates/denosumab to improve bone mineral density. A serum 25(OH)D of 50-75 nmo/l and normal dietary calcium intake should be maintained in both primary and secondary hyperparathyhroidism.
Dr Kevin McCarroll is a consultant physician & geriatrician specialising in Bone Health & Osteoporosis at St James’s Hospital, Dublin where he is a Clinical lead of the Bone Health Unit, the largest facility of its kind in Ireland. He is also a Clinical Senior Lecture at Trinity College and a co-investigator in the Trinity Ulster, Dept of Agriculture (TUDA) study of over 5000 older adults. He is currently conducting research on secondary hyperparathyroidism and its effects on bone mineral density. He has also contributed significantly to Vitamin D research in Ireland in recent years.