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Can someone post a link to explain secondary and tertiary hyperparathyroidism?
I still dont understand the difference
I appreciate any input
No link, here is the explanation.
(1) Primary Hyperparathyroidism is from an adenoma, an autonomously secreting "tumor" that just pumps out Parathyroid Hormone (PTH) independent of the calcium. This causes the calcium levels to rise, shutting off the normal parathyroid glands. This causes a single gland hypertrophy (the adenoma) and a multiple gland atrophy (the other three). It produces a high PTH state, which increases Ca from the bones, kidneys, and gut (through Vit D), and it gets rid of Phosphorous in the kidneys.
The key here is that it is a benign (rarely malignant) tumor that secretes PTH on its own. Treat this with surgery of the single adenoma, follow up calcium.
(2) Secondary Hyperparathyroidism is in response to renal failure. You need your kidneys to make Vitamin D and absorb calcium from the gut. The signal to make Vitamin D is PTH. So if your PTH is healthy, and your kidneys are busted, you make PTH, but no Vitamin D. This causes an absence of calcium absorption from your diet. Low calcium levels cause PTH to be secreted, secreted in a larger amount than normal has the parathyroid tries to bring calcium levels up to normal. Thus there is an elevated PTH, a normal calcium, and a low phos (in this stage, the tubules still excrete phos but do not make vit D).
The key here is that because Vitamin D is broken, calcium is low, and the parathyroid increase is a normal physiologic response to low calcium. Treat this with exogenous vitamin D and calcium to prevent tertiary hyperparathyroidism.
(3) Tertiary Hyperparathyroidism is a result of secondary. It looks and feels exactly like primary hyperparathyroidism in that it autonomously produces PTH, regardless of calcium levels. The difference is that it is not a tumor, it is not an adenoma. Instead, it is a hypertrophied parathyroid gland from years of stimulation secondary to low calcium. The constant need to secrete PTH to make up for the absent Vitamin D can shift from a normal gland to a gland that continuously secretes PTH.
The key to this is that it is an autonomously operational gland that got that way because of secondary hyperparathyroidism. Treat this with surgery, then calcium and vit D supplementation.
Mitral Stenosis - High Yeild Topics For USMLE, 10 Points You Should Know
Rheumatic heart disease (most common), congenital (rare)(MCQ)
Most cases occur in women.(MCQ)
Signs and symptoms
Dyspnea on exertion (DOE)(MCQ)
Systemic embolism (due to stagnation of blood in enlarged left atrium)
Accentuated right ventricle precordial thrust
Signs of right ventricular failure(MCQ)
due to enlarged left atrium impinging on recurrent laryngeal nerve
mid-diastolic with opening snap
Read more at news4medico dot com/mitral-stenosis/
1132 High Yeild Topics for USMLE
My wife had the bone hyperparathyroidism. We went with her to the doctor, he put an accurate diagnosis of the disease and the main reason is the lack of calcium in the diet. Wife changed her diet and started taking natural products, such as http://www.kalinka-store.com/catalog/54 to enhance immunity. Six months later went improvement. There are many factors hyperparathyroidism, so here it is necessary to know the exact diagnosis that would give advice
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