HYPERPARATHYROIDISM

• It is caused by overproduction of parathormone by the parathyroid glands, it is characterized by bone decalcification and the development of renal calculi containing calcium.

Primary Hyperparathyroidism

• It affects women two to four times more frequently than men and is most common in people between 60 and 70 years of age.

• Approximately 25 cases per 100,000 .• Rare in children younger than 14 years of age..• Increases 10 – fold between the ages of 15

and 65 years.

Secondary Hyperparathyroidism

• With manifestation similar to those of primary hyperparathyroidism

• Occurs in patient who have chronic renal failure and so called renal rickets.

one (occasionally more than one) parathyroid gland grows into a tumor.

Release excess amount of PTH

Release into the blood stream

Travels into the bone and removes calcium

Signs and symptoms will occur

What Causes Hyperparathyroidism?

Hyperparathyroidism Cause #1: One of the parathyroid glands grew into a tumor. This is 75% of all parathyroid patients. No Known Cause.

Hyperparathyroidism Cause #2: TWO of the parathyroid glands grew into a tumor. This is 20% of all parathyroid patients. No Known Cause.

Hyperparathyroidism Cause #3: Radioactive Iodine Therapy in the Past for Thyroid Problems. This is about 1.5% of all parathyroid patients.

• Hyperparathyroidism Cause #4: Radiation treatments to the neck and face as a youth or teenager. This is 1.5% of all parathyroid patients.

• Hyperparathyroidism Cause #5: Long term use of Lithium. This is about 1.5% of all parathyroid patients.

• Hyperparathyroidism Cause #6: Familial (Hereditary) Forms of Hyperparathyroidism. This is about 1% of all parathyroid patients.

• Hyperparathyroidism Cause #7: All Four of the parathyroid glands grow big

• Hyperparathyroidism Cause #8: Multiple Endocrine Neoplasia Syndromes (MEN Syndromes). This is far less than 1% of all parathyroid patients.

• Cause #9: Kidney Disease. This is actually a different disease -- Secondary Hyperparathyroidism.

Clinical Manifestations

• apathy• fatigue• muscle weakness• nausea • vomiting• constipation• Hypertension

• cardiac dysrythmias• irritability• neurosis to psychoses• skeletal pain and tenderness• pain on weight bearing

• pathologic fractures• deformities• shortening of body stature • Incidence of peptic ulcer and pancreatitis is

increased , and may responsible for many of GI symptom that may occur.

Assessment

• Persistent elevation of serum calcium levels .

• Elevated concentration of parathormone.

8.8 – 10.2 mg/dl (normal value of serum calcium)14 – 65 pg/ml (normal value of parathormone)

Diagnostic

• Radioimmunoassays• Double – antibody parathyroid hormone test• X-ray• Ultrasound• MRI• Thallium scan• Fine needle biopsy

MEDICAL MANAGEMENT

Surgical Management

• Parathyroidectomy unilateral neck exploration using local

anesthesia.Performed on an outpatient basis.

For asymptomatic patient . . . .

• Surgery may be delayed and the patient monitored closely for worsening of hypercalcemia, bone deterioration, renal impairment, or the development of kidney stones.

Criteria 1. Younger than 50 y/o2. Unable or unlikely to participate in follow-up care.3. Serum calcium level more than 1.0 mg/dL (0.25

mmol/L) above normal reference range4. Urinary calcium level greater than 400 mg/day (10

mmol/day)5. 30% or greater decrease in renal function6. With complains of primary hyperparathyroidism,

including nephrocalcinosis, osteoporosis or a sever psychoneurologic disorder.

Management • Fluid intake of 2000 ml/day or more.• Cranberry Juice• Avoid dehydration• Avoid diet with restricted or excess

calcium.

Nursing Management

• Obtain baseline serum potassium, calcium, phosphate, and magnesium levels before treatment.

• Provide at least 3 liters of fluid per day, including cranberry or prune juice, to increase urine acidity and help prevent calculus formation.

• Schedule care to allow the patient with muscle weakness as much rest as possible.

• Provide comfort measures to alleviate bone pain.

• Administer antacids, as appropriate to prevent pelvic ulcers.

• Auscultate the lungs regularly. Check for signs of pulmonary edema in the patient receiving large amounts of normal salinesolution, especially if he has pulmonary or cardiac disease.

• Assess the patient for parathyroid poisoning, musculoskeletal changes, and renal impairment.

• Observe the patient for signs of pain and monitor him for effectiveness of analgesics and comfort measures.

Complication

• Hyper Calcemic Crisis – can occur with extreme elevation of serum calcium levels greater than 15 mg/dl (3.7 mmol/L) result in neurologic, cardiovascular, and renal symptoms than can be life threatening.

Statistics• 2, 350 patient per year had have

Parathyroidectomy. (Tampa)

• One case of cancer ever 5 years.• 1 in 800 people has hyperparathyroidism in

male• 1 in 250 people has hyperparathyroidism in

female over age 50.