HYPERPARATHYROIDISM AND ITS MANAGEMENT

HYPERPARATHYROIDISM AND ITS MANAGEMENT

Hyperparathroidism is overactivity of parathyroid glands resulting in excess production of parathyroid hormone consequently leading to increased serum calcium .

Primary hyperparathroidism is commonly diagnosis based on evaluated calcium levels found on laboratory test results in asymptomatic patients.

ETIOLOGY 

• Primary cause :- One or more parathyroid glands enlarge and increase PTH secretion .most commonly caused by single adenoma .

• Secondary Cause :- Hypocalcemia producing abnormalities outside the parathyroids causes excessive compensatory production of parathyroid hormone.

CAUSES

1.Rickets , vit-D deficiency

2.Chronic Renal Failure 

3.Osteomalacia due to phenytoin

4.Pregnancy and lactation

PATHOPHYSIOLOGY

CLINICAL MANIFESTATIONS

• Depression
• Confusion 
• Lethargy
• Arrythmias
• Nausea and. Vomiting
• Constipation
• Atrophy of muscles 
• Weakness and fatigue

DIAGNOSTIC EVALUATION 

• History collection and physical examination

• Persistent evaluation of serum calcium levels
• An elevated concentration of Parathyroid Hormones
• Bone changes may be detected on X-Ray or bone scan
• Double antibody parathyroid hormone test is used to distinguish between primary hyperparathroidism and malignancy as a cause of hypercalcemia .
• Ultrasound
• Magnetic resonance imaging
• Thallium scan
• Fine needle biopsy 

MANAGEMENT 

• Primary cause management 

1.Hydration Therapy 

Patients with hyperparathroidism are at risk for renal calculi  daily fluid intake of 2000ml or more is encouraged to help prevent Calculus formation.

Because of the risk of hypercalcemic crisis the patient is instructed to avoid dehydration and to seek immediate health care if conditions that commonly produce dehydration (eg.vomiting , diarrhoea).

2. Diet and medications :-

Limited dietary intake of calcium ,and promoting sodium and calcium excretion through forced diuresis and use of lasix or if surgery isn't feasible or necessary.

IV magnesium and phosphate or sodium phosphate solutions by mouth or retention enema , possible supplemental calcium ,vitamin-D .

3. Mobility :-

The nurse encourages the patients to be mobile.

• Secondary cause management 

1.Correcting Vitamin D

2.Dialysis for patients with renal failure .

• SURGICAL MANAGEMENT 

1. Parathyroidectomy :- Surgical removal of abnormal parathyroid tissue.

2.For Asymptomatic patients

Patients who have only mildly evaluated serum calcium concentration and normal kidney function surgery may be delayed.

Patients monitored closely for worsening of hypercalcemia bone deterioration renal impairment or the development of kidney stones.