DISEASES OF THE PARATHYROID - CLINICAL FINDINGS
Pancreatic Disease	Symptoms	Signs	Abnormal Lab Test Results	Abnormal Imaging Findings	Initial Treatment	General and Follow-Up Treatment	Age Range(s) Typically Found	Prognosis
Primary Hyperparathyroidism	Fatigue, bone pain, nephrolithiasis, depression, abdominal pain	Hypertension, kidney stones, osteopenia, psychiatric symptoms	↑PTH, ↑Calcium, ↓Phosphate, ↑Alkaline phosphatase	Parathyroid adenoma on sestamibi scan, bone resorption on X-ray	Parathyroidectomy if symptomatic or severe; hydration, bisphosphonates	Monitor calcium levels, kidney function, bone density	Middle-aged and older adults, more common in women	Good with treatment, can lead to osteoporosis and kidney damage if untreated
Secondary Hyperparathyroidism	Bone pain, muscle weakness, renal osteodystrophy, pruritus	Signs of chronic kidney disease, bone deformities	↑PTH, ↓Calcium, ↑Phosphate, ↑Alkaline phosphatase	Diffuse bone demineralization, vascular calcifications	Treat underlying kidney disease, vitamin D and phosphate binders	Manage kidney disease, monitor PTH and calcium levels	Patients with chronic kidney disease	Depends on underlying kidney disease, can progress to tertiary
Tertiary Hyperparathyroidism	Hypercalcemia symptoms, bone pain, renal stones	Renal osteodystrophy, pathologic fractures	↑PTH, ↑Calcium, ↑Phosphate, ↑Alkaline phosphatase	Parathyroid hyperplasia on imaging, renal calcifications	Parathyroidectomy if severe, calcium and vitamin D supplementation	Monitor calcium and PTH post-surgery, correct vitamin D deficiency	Patients with long-standing secondary hyperparathyroidism	Good with surgery, but requires lifelong monitoring
Hypoparathyroidism	Muscle cramps, paresthesia, seizures, dry skin, brittle nails	Chvostek’s sign, Trousseau’s sign, cataracts, hyperreflexia	↓PTH, ↓Calcium, ↑Phosphate, ↓Alkaline phosphatase	No specific parathyroid mass, basal ganglia calcifications	Calcium and vitamin D supplementation, recombinant PTH if needed	Lifelong calcium and vitamin D therapy, monitor for complications	Any age, congenital or post-surgical	Good with treatment, but requires lifelong supplementation
Pseudohypoparathyroidism	Short stature, round face, brachydactyly, muscle cramps	Short fourth/fifth digits, developmental delay	↑PTH, ↓Calcium, ↑Phosphate, normal Alkaline phosphatase	Subperiosteal bone resorption, short metacarpals	Calcium and vitamin D supplementation	Monitor growth and development, maintain normal calcium levels	Childhood, early adulthood	Good with treatment, lifelong management needed
Parathyroid Carcinoma	Hypercalcemia, bone pain, fatigue, kidney stones, weight loss	Palpable neck mass, severe hypercalcemia, recurrent laryngeal nerve palsy	↑PTH, ↑Calcium, normal or ↑Phosphate, markedly ↑Alkaline phosphatase	Large parathyroid tumor, metastases if advanced	Surgical resection, calcium-lowering agents	Frequent monitoring of calcium, early detection of metastasis	Middle-aged to older adults, rare but aggressive	Poor if metastatic, better with early detection and surgery