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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.