Hiperparatireoidismo secundário
Summary
Definition
History and exam
Key diagnostic factors
- presença de fatores de risco
- características da doença renal crônica
- características de síndrome de má absorção subjacente
Other diagnostic factors
- cãibras musculares e dor óssea
- formigamento perioral ou parestesia nos dedos das mãos ou dos pés
- sinal de Chvostek
- sinal de Trousseau
- pernas arqueadas ou joelhos varos
- fraturas
Risk factors
- envelhecimento
- doença renal crônica
- deficiência de vitamina D: exposição inadequada à luz solar
- deficiência nutricional (especialmente ausência de laticínios e peixes)
- deficiência de vitamina D: má absorção
- deficiência de vitamina D: disfunção hepática
- deficiência de vitamina D: distúrbio genético
- deficiência de vitamina D: obesidade
- uso de medicamentos
Diagnostic tests
1st tests to order
- cálcio sérico
- nível de paratormônio intacto sérico
- creatinina sérica
- ureia sérica
Tests to consider
- fósforo sérico
- 25-hidroxivitamina D sérica
- magnésio sérico
- ultrassonografia do pescoço
- exame de imagem com 99Tc-sestamibi (MIBI)
- tomografia computadorizada (TC) com contraste de alta resolução de pescoço e região superior do tórax
- ressonância nuclear magnética (RNM) do pescoço e região superior do tórax
Treatment algorithm
falta de exposição solar
relacionado à má absorção
DRC de estágios 3 a 5D
Contributors
Authors
Syazrah Salam, MBChB, PhD, FRCP
Metabolic Bone and Nephrology Consultant
Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust
UK
Disclosures
SS declares that he has no competing interests.
Arif Khwaja, PhD, FRCP
Consultant Nephrologist
Sheffield Kidney Institute
Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust
UK
Disclosures
AK declares that he has no competing interests.
Acknowledgements
Dr Arif Khwaja and Dr Syazrah Salam would like to gratefully acknowledge Dr Hugh Gallagher, Dr Louise Ross, Dr Brendan C. Stack Jr, Dr David J.A. Goldsmith, and Dr Kiran Haresh Kumar Patel, previous contributors to this topic.
Disclosures
HG, LR, BCS, DJAG, and KHKP declare that they have no competing interests.
Peer reviewers
Fong-Fu Chou, MD
Department of Surgery
Chang Gung Memorial Hospital-Kaohsiung Medical Center
Chang Gung University College of Medicine
Kaohsiung Hsien
Taiwan
Disclosures
Not disclosed.
Victor Schneider, MD
Clinical Associate Professor of Medicine
Uniformed Health Services University of the Health Sciences
Bethesda
MD
Disclosures
VS declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Update Work Group. KDIGO 2017 clinical practice guideline update for the diagnosis, evaluation, prevention, and treatment of chronic kidney disease-mineral and bone disorder (CKD-MBD). Kidney Int Suppl (2011). 2017 Jul;7(1):1-59.Full text Abstract
Holick MF, Binkley NC, Bischoff-Ferrari HA, et al; Endocrine Society. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011 Jul;96(7):1911-30.Full text Abstract
Petranović Ovčariček P, Giovanella L, Carrió Gasset I, et al. The EANM practice guidelines for parathyroid imaging. Eur J Nucl Med Mol Imaging. 2021 Aug;48(9):2801-22.Full text Abstract
American College of Radiology. ACR appropriateness criteria: parathyroid adenoma. 2021 [internet publication].Full text
National Institute for Health and Care Excellence. Chronic kidney disease: assessment and management. Nov 2021 [internet publication].Full text
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Hiperparatireoidismo primário
More DifferentialsGuidelines
- The EANM practice guidelines for parathyroid imaging
- ACR appropriateness criteria: parathyroid adenoma
More Guidelines
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