Hyperparathyroidism etiology

A. E. Sizemore, G. W. Arnaud, C. D. "Etiology of Hyperparathyroidism and Bone Disease During Chronic Hemodialysis. III. Evaluation of Parathyroid Suppressability". J. Clin. Invest. (1973), 52, 173-180. 

Common and many of the uncommon etiologies of hypercalcemia are listed in Box 49-2. Primary hyperparathyroidism is the most common cause in outpatients, whereas mahgnancy is the most common cause in hospitalized patients. Together, these two disorders account for 90% to 95% of all cases of hypercalcemia. 

Patients with CKD are at increased risk of cardiovascular disease, independent of the etiology of their kidney disease. While a clearly unique pathogenesis of cardiovascular disease specific to CKD has not been identified, it is known that manifestations of kidney disease are contributory. Risk factors for cardiovascular disease in this population include hemodynamic and metabolic abnormalities, as well as hypertension, dyslipidemia, elevated homocysteine levels, anemia, hyperparathyroidism, malnutrition, and oxidative stress. Hypertension induced by volume expansion and increased systemic vascular resistance increases myocardial work and contributes to development of left ventricular hypertrophy (LVH). Hyperlipidemia may enhance atherogenesis, while some uremic toxins can decrease myocardial contractflity. In addition, uremic toxins can induce pericarditis, a potentially fatal complication. Currently, measures to screen this high-risk population for cardiovascular risk factors are not routine. ... 

Osteoporosis and osteitis fibrosa cystica Metastatic calcifications vi. Neurologic changes Secondary hyperparathyroidism a. Etiology... 

PTH antagonists may also have diagnostic value. Since PTH plays a role in the minute-to-minute regulation of blood calcium levels, short-term administration of a PTH antagonist may cause a rapid reduction in blood calcium levels in hypercalcemic patients if the hypercalcemia is due to elevated PTH levels. Similarly, short-term amelioration of possible symptoms of hypercalcemia (such as lethargy, cognitive defects) may help pinpoint the etiology of the symptoms (i.e. hyperparathyroidism vs. other disorders). 

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