Endocrine & metabolic · UKMLA & AKT
Primary hyperparathyroidism
A free high-yield preview for the UKMLA Applied Knowledge Test, covering how to recognise this condition. The full SA Note notes add investigations, management and complications, with practice questions on this topic.
Key high-yield points
- Solitary parathyroid adenoma - 85%; most common cause
- Multiglandular hyperplasia - 10-12%; often familial (MEN1, MEN2A)
- Multiple adenomas - 4-5%
- Parathyroid carcinoma - <1%; causes markedly elevated PTH and severe hypercalcaemia
Why is phosphate LOW? PTH increases renal phosphate excretion - the renal wasting effect dominates over bone resorption release, giving net hypophosphataemia. This distinguishes primary HPT (low phosphate) from secondary HPT in CKD (high phosphate).
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