Hyperparathyroidism is characterized by excessive activity of one or more of the four parathyroid glands caused by the secretion of parathyroid hormone (parathyroid hormone-PTH) excess.
Such hypersecretion facilitate bone resorption and causes hypercalcemia and hypophosphatemia. Signs and symptoms of primary hyperparathyroidism caused by hypercalcaemia and usually appear in several body systems.
In the diagnosis of primary hyperparathyroidism generally through higher levels of calcium that are found in the laboratory profile of patients who have no symptoms (asymptomatic). Primary hyperparathyroidism affects women three times more than men.
Causes of Hyperparathyroidism
- Adenomas.
- Chronic renal failure.
- Vitamin D or calcium absorption by the intestine decreases.
- Deficiency of vitamin D or calcium in the diet.
- Genetic disorders.
- Idiopathic.
- Undigested drugs, such as phenytoin.
- digested laxative.
- Multiple endocrine neoplasia.
- Osteomalacia
Signs and Symptoms of Hyperparathyroidism
- Central nervous system: psychomotor and personality disorders, depression, psychosis visible, stupor and coma possibility
- GI: pancreatitis that causes constant and severe epigastric pain that radiates to the back, peptic ulcer causing abdominal pain, anorexia, nausea and vomiting
- Neuromuscular: weakness and muscle atrophy, especially in the legs
- Renal: polyuria, nephrocalcinosis due to higher calcium levels and the possibility of recurrent nephrolithiasis, can cause renal insufficiency
- Skeletal and articular: chronic pain in the lower back and susceptible to fractures due to bone degeneration, bone softening, kondrokalsinosis, osteopenia and osteoporosis, especially in the vertebrae, erosion yuksta-articular surface, subchondral fracture, traumatic synovitis and pseudogout.
Diagnostic Test
Primary Disease
- High serum PTH concentrations in radioimmunoassay with hypercalcemia that accompanies confirm the diagnosis.
- X-rays showed diffuse demineralization of bone, bone cysts, outer cortical bone absorption, and subperiosteal erosion of the distal phalanx and klavikel
- Microscopic examination of the bone with the test, such as X-ray spectrometry showed increased bone turnover
- Laboratory testing showed increased levels of calcium and chloride serum and urine and serum phosphorus levels down
- Hyperparathyroidism can raise uric acid and creatinine levels as well as basal acid secretion and serum levels of gastrin imunoreaktif
- The increase in serum amylase levels may indicate acute pancreatitis.
Secondary Diseases
- In patients with secondary hyperparathyroidism, results of laboratory tests showed serum calcium levels were normal or slightly down and the various levels of serum phosphorus, especially if hyperparathyroidism caused by riket, oesteomalasia, or kidney disease
- Laboratory values and other physical examination findings identify the causes of secondary hyperparathyroidism.
Handling Actions
Primary Disease
- Surgically removing adenoma or hyperplasia depending on the level, all but half of one gland (gland remaining parts needed to maintain normal PTH levels)
- Add fluid intake
- Limit your intake of calcium in the diet
- Perform infusion of normal saline solution I.V.
- Furosemide or ethacrynic acid helps excretion of sodium and calcium
- Oral sodium or potassium phosphate, calcitonin, or plicamycin also be used to help the excretion of sodium and calcium
- Giving IV magnesium and phosphate or sodium phosphate solution by mouth or retention enema can be given if the patient has the potential of magnesium and phosphate deficiency after surgery
- Calcium supplements are given during the first 4 to 5 days after surgery, if low levels of normal serum calcium
- Vitamin D or calcitriol can also be used to raise serum calcium levels.
Secondary Diseases
- Correction causes hypertrophy paratoroid with vitamin D therapy or in patients suffering from kidney disease, calcium preparations give oran to lower calcium levels.
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