Nutritional secondary hyperparathyroidism

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Sections available in full article Introduction, Presenting signs, Acute presentation, Age predisposition, Pathogenesis, Etiology, Pathophysiology, Timecourse (incubation, duration), Diagnosis, Presenting problems, Client history, Clinical signs, Diagnostic investigation, Confirmation of diagnosis, Gross autopsy findings, Histopathology findings, Differential diagnosis, Treatment, Initial symptomatic treatment, Standard treatment, Subsequent management, Prevention, Prophylaxis, Sequelae, Prognosis, Expected response to treatment, Reasons for treatment failure, Sources, Publications, Vetstream contributor(s),
Contributors Dr Penney Barber BVMS MRCVS

Introduction

  • Bone disorder caused by excess parathyroid hormone (PTH) usually the result of poor nutrition.
  • Cause : diet with excess phosphorus or low calcium.
  • Signs : bone pain, stiffness, neurological signs.
  • Diagnosis : history, laboratory data, radiography.
  • Treatment : strict rest, dietary modification.
  • Prognosis : good if treated early.

Diagnosis

Clinical signs

  • Bone pain.
  • Swollen costochondral junctions and metaphyses.
  • Ataxia if neurological involvement.
  • Limb deformity.

Diagnosis

Differential diagnosis

  • Renal secondary hyperparathyroidism Renal secondary hyperparathyroidism.
  • Congenital bone disorders.
  • Metaphyseal osteopathy.
  • Storage disease Storage disease.
  • Other causes of osteopenia:
    • Disuse atrophy.
    • Pseudohyperparathyroidism.
    • Hyperadrenocorticism Hyperadrenocorticism.

Sequelae

Prognosis

  • Good if treated early.
  • Guarded if severe limb deformity or pathological fractures (particularly if neurological signs present) at time of diagnosis.

Expected response to treatment

  • Reduced discomfort should be apparent within a few days of strict rest.
  • Radiographical improvement may not be seen for weeks to months.

    Fracture healing may be slow.

Reasons for treatment failure

  • Incorrect diagnosis.
  • Severe damage done by time of diagnosis.

Sources

Publications

Refereed papers

  • Tomsa K, Glaus T, Hauser B, Fluckiger M, Arnold P, Wess G & Reusch C (2000) Nutritional secondary hyperparathyroidism in six cats. JSAP 40 (11), 533-532.
  • Krook L, Lutwak I L, Henrikson P, Kallfelz F, Hirsch C, Romanus B, Belnager L F, Marier J F & Sheffy B E (1971) Reversibility of nutritional osteoporosis. J Nutr 101 , 233-246.

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