Hyperparathyroidism Flashcards
What is Hyperparathyroidism?
Increased secretaries of parathyroid hormone (PTH)
- ⬆️ PTH = ⬆️ Ca+
What does PTH regulate?
- Calcium
- Phosphorus
How?
-stimulates bone reabsorption of calcium
-Stimulates renal tubular reabsorption of calcium
-Activation of Vitamin D
Primary Hyperparathyroidism
Due to ⬆️ PTH which leads to disorders of Ca+, Phosp, and bone metabolism.
Most common cause: Benign Tumor or hyperplasia of parathyroid gland
Adenoma - TUMOR
Secondary Hyperparathyroidism
MOST COMMON Compensation for conditions that cause/induce hypocalcemia - Vitamin D deficiency - Malabsorption - CKD - Hyperphosphatemia
Tertiary Hyperparathyroidism
- Occurs when hyperplasia of the parathyroid gland
- There is a loss of negative feedback from circulating Ca+ levels
- Autonomous secretion of PTH EVEN if Ca+ levels are normal
Example: patients who’ve have a kidney transplant after long TX of dialysis due to CKD
Clinical manifestations I
- Decreased bone density: PTH takes Ca+ from bone
- Cyst Formation: Ca+ depletion from bone leads to cyst in bones
- General weakness: ⬆️Ca+ = electrical conduction & muscle contractions. Muscle will not be able to perform.
- Hypercalciuria: ⬆️ Ca+ in urine
Clinical Manifestations II
- Calculi Formation (Nephrolithiasis) : High risk for Renal Stones
- Osteoporosis: 2/2 decreased bone density
- Fractures: Long bone, rib, and vertebral fractures
Cardiovascular Manifestations
- Dysrhythmia: increased calcium, heart goes into dysthymia
- Shortened QT intervals: ⬆️Ca+= faster contractions. This leads to shortened QT intervals
- Hypertension: 2/2 Shortened QT intervals which are 2/2 ⬆️ contractions due to ⬆️Ca+
Neurological Manifestations
- Shortened attention span
- emotional irritability
- hyperactive deep tendon reflexes
- HA
- parathesia
- confusion, depression, delirium, psychosis, coma
Musculoskeletal Manifestations
Decalcification of Bones leads to:
- backache - weakness
- fatigue - pain on weight bearing
- osteoporosis - pathological fractures of long bones
- decreased muscle tone
- muscle atrophy: ⬆️ ca+= ⬆️ muscle contraction. Too much that muscle stop responding = ⬇️ muscle tone = muscle atrophy
Gastrointestinal Manifestations
- Anorexia
- vague abdominal pain
- N/V -weight loss
- constipation - pancreatitis
- Peptic Ulcer disease (PUD)
- Cholelothiasis: Stone formation
Renal manifestations
- Hypercalciuria
- Renal stones
- UTI
- Polyuria: A lot of solutes in your urine. Body wants to dilute. Starts to pull water into bladder & kidneys = polyuria
Integumentary Manifestations
- REMEMBER THAT* (Lecture)
- Moist Skin
-Skin necrosis
Diagnostic for Hyperparathyroidism
- ⬆️PTH
- ⬆️ Serum Ca+ > 10 mg/dL Normal (8.5-10.3)
- ⬆️ urine Ca+
- ⬇️ Phosphate < 3mg/dL Normal ( 2.5-4.5)
- Electrolytes (Na+, Cl, Cr, amylase)
- Bone-density: detects bone loss
- X-rays, UTZ, MRI, Thiallium Scan: looking for depletion in the bone , used to R/O cancer of the bone
Surgical treatment for Hyperparathyroidism
Parathyroidectomy (partial/ complete)
- parathyroidectomy leads to rapid reduction of ⬆️ Ca+ lvls
Auto-transplantation
- normal parathyroid tissue it implanted in forearm or by sternocleidomastoid muscle
- this allows PTH to continue to normalize Ca+ lvls
Criteria for Parathyroidectomy
- ⬆️ Ca+ levels > 12 mg/dL Normal (8.5-10.3)
- ⬆️ urine Ca+ > 400 mg/dL
- Decreased bone mineral density
- Renal calculi
Non surgical treatment for Hyperparathyroidism
- Diet: ⬇️Ca+ ⬆️ Phosphorus ⬆️ Fluid
- Monitor : PTH, Ca+, phosphorus, renal function (BUN, Cr)
- Monitor Urine: Urinary calcium
- Ambulation: less stress= less calcium
Fat= less likely for osteomyelitis
Bedrest = ⬆️ calcium excretion & ⬆️ risk for calculi formation
Pharmacological management Hyperparathyroidism I
Phosphorus Supplement: Bisphosphonates
- ⬇️ Ca+ levels. Inhibits osteoclasts bone reabsorption & rapidly normalizes serious Ca+ lvls.
Estrogen/ Progestin
- ⬇️ serum & urine Ca+ levels. Delays demineralization of skeleton
Oral Phosphate
- Inhibit calcium- absorbing effects of Vitamin D in GI
Pharmacological management of Hyperparathyroidism II
Diuretics - ⬆️urinary excretion of Ca+ Calcimimetic Agent: Sensipar - ⬆️ sensitivity of Ca+ receptors in parathyroid gland = ⬇️ PTH release - ⬇️ PTH release = ⬇️ Ca+ lvls - Spares Ca+ storage in bones
Complication fo Hyperparathyroidism
- Tetany: Unpleasant thing,ing of hands & mouth. Removal of parathyroid = rapid ⬇️Ca+ = Tetany & Hemorrhage
- Hemorrhage: Ca+ essential for clotting
- Laryngospasms
- (+) Chvostek sign: abnormal hyper excited FACIAL NERVE
- (+) Trousseau sign: BP cuff inflates= Carpopedal spasm (HAND)
Hypercalcemic Crisis
- ⬆️Serum Ca+ >15 mg/dL Normal (8.5-10.3)
- results in Neurological, Cardiovascular, and Renal symptoms
Pharmacological management of Hypercalcemic Crisis
-Rehydration: Large Vol BOLUS (3) - 1000 cc NaCl or D5W.
Trying to ⬇️ Ca+ or patient becomes asymptotic
- Diuretic: promotes Renal excretion of Ca+
- Phosphate Therapy
- Cytotoxic agents: Mithramycin- ⬇️ serum Ca+
- Dialysis: VERY symptomatic
- Calcitonin* google* opposes action of PTH
Interactions for Hyperparathyroidism & Hypercalcemic Crisis
- I&O
- IV Calcium Gluconate
- Monitor electrolytes
- Frequently monitor s/s (+) Chvostek & Trousseau sign
- Mobility to promote Bone calcification
