Explain the general patho of hyperparathyroidism
Increased secretion of PTH
-lead to hypercalcemia
Primary hyperparathyroidism
Increased PTH- usually caused by benign tumor
Secondary hyperparathyroidism
A compensatory response to conditions that caused hypocalcemia
-body over-compensates and releases too much PTH and suddenly hypocalcemia becomes hypercalcemia
Tertiary hyperparathyroidism
Hyperplasia (increased number of cells) of the parathyroid glands and a loss of negative feedback from circulating calcium levels
Can happen to patients who have had kidney transplants
How does hyperparathyroidism affect:
phosphate levels
skeletal system
renal system
pancreas
High calcium causes low phosphate
Increased calcium resorption from bones leads to decreased bone density and osteoporosis
Hypercalcemia in the kidneys can lead to calculi formation into kidney stones
Pancreatitis is possible
What are general manifestations of hyperparathyroidism?
Weak, loss of appetite, emotional disorder, constipation, increased need for sleep, shortened attention span, osteoporosis, fractures, kidney stones, muscle weakness in LE
How is hyperparathyroidism diagnosed?
High PTH
High serum calcium
Low serum phosphate
What is the most effective treatment of primary and secondary hyperparathyroidism?
Surgery
-partial or complete removal of parathyroid glands
When is nonsurgical treatment indicated for hyperparathyroidism?
What does it consist of?
-labs, screening, diet, meds
used for patients with little to no symptoms
Regularly measure PTH, calcium, phosphate
X-rays: check for bone disease
Maintain high fluid intake, moderate calcium intake
Biphosphonates can inhibit osteoclastic bone resoprtion and rapidly normalize serum calcium levels
Oral phosphate can be used to inhibit the calcium-absorbing effects of Vitamin D
How is acutely elevated serum calcium treated?
IV NS
Loop diuretics (furosemide)
Hypoparathyroidism
-patho?
-most common causes?
Uncommon: inadequate PTH leads to low calcium levels
Most common cause:
-accidental parathyroid removal
-damage to vascular supply during neck surgery
-low magnesium can suppress PTH secretion
How does hypoparathyroidism affect phosphate levels?
How does this manifest?
Leads to high phosphate
Seizures, tetany, laryngospasm, CNS abnormalities
How does hypocalcemia with hypoparathyroidism present?
Tetany
-tingling of lips, extremities stiffen
Dysphagia, laryngospasms
Lethargy, anxiety, personality changes
Positive Chvostek and Trousseau signs
How is tetany treated in an emergency case of hypoparathyroidism?
IV calcium
Push slowly while monitoring ECG
Can cause hypotension and cardiac arrest, or IV extravasation
What dietary changes can be made for long-term management of hypoparathyroidism?
oral calcium supplements
Vitamin D
Why is PTH hormone not used for long-term management of hypoparathyroidism?
Expensive and must be IV
What kind of breathing strategies can be used for someone experiencing tetany from hypoparathyroidism?
Rebreathing exercises
Creates acidic environment for body, enhancing the ionization of calcium
