Please enable JavaScript.
Coggle requires JavaScript to display documents.
Hyperparathyroidism (excessive amount of PTH…
Hyperparathyroidism (excessive amount of PTH produced by the parathyroid glands)
Diagnostic investigations
Serum Calcium (high)
PTH test (high)
Serum Phosphate (low)
Urine Calcium (normal or high)
Parathyroid imaging: Ultrasound, CT scan, MRI
Bone density measurement, X-ray of bone
Complications
Pathologic long bone fracture (fractures that happen without trauma or from minor stress)
Urinary tract infection (High calcium in urine can irritate the urinary tract, making it more prone to infections)
Peptic Ulcer & Pancreatitis (high calcium can Stimulate gastric acid production, leading to peptic ulcers and Activate pancreatic enzymes, triggering inflammation of the pancreas (pancreatitis)
Painful Ischemic Necrosis of Skin & Gangrene (calcium can build up in blood vessels of the skin can lead to ischemia, necrosis, and eventually gangrene)
Cardiac arrhythmia (high calcium can affect heart rhythm and increase blood pressure)
Respiratory failure (Long-term high calcium can lead to soft tissue calcification (calcium deposit)
in lungs, trachea or blood vessels in the lungs. This stiffens the lung tissue → restrictive lung disease → respiratory failure over time)
Types of Hyperparathyroidism
Secondary hyperparathyroidism
: in CKD kidneys cannot activate vitamin D properly and less calcium is absorbed from the gut. The kidneys also cannot excrete phosphate that well. High phosphate binds with calcium, lowering blood calcium, stimulates parathyroid glands to make more PTH
CKD
Tertiary hyperparathyroidism
: After long term secondary hyperparathyroidism, the parathyroid glands become autonomous and continue producing high PTH even after calcium levels have been corrected. (eg after a kidney transplant)
ESRD
Primary hyperparathyroidism
: The parathyroid gland itself becomes abnormal and produces too much PTH
Parathyroid adenoma
Parathyroid Carcinoma
Signs & Symptoms
Skeletal Manifestations
: high PTH pulls calcium out of the bones
Fragile bones
Bone pain
Hypercalcemia manifestations
: Too much calcium is pulled out of the bones, kept in the blood and absorbed from food = hypercalcemia
Neuromuscular
Muscle weakness
Fatigue
Decreased reflexes
Neuropsychiatric
Depression
Confusion
Anxiety
Memory problems
Cardiovascular system
High blood pressure
Shortened QT interval
Renal
Nephrolithiasis
Polyuria
Dehydration
Hypercalciuria
Gastrointestinal
Constripation
Nausea
Vomiting
Abdominal pain
Skin
Pruritis
Treatment & Management
Assess vital signs, monitor serum BUN and creatinine, serum calcium
Avoid large doses of thiazide diuretics, vitamin A, and calcium-containing antacids or supplements
Increase fluid intake
Parathyroidectomy
Medications:
Bisphosphonates
Denosumab
Vitamin D and vitamin D analogs
Estrogen replacement
Increase mobilisation
Nursing Diagnosis
Chronic pain related to low bone density as evidenced by joint pain
Excessive fatigue burden related to excessive parathyroid hormone as evidenced by muscle weakness, lethargic.
Inadequate nutritional intake related to inadequate appetite and vomiting as evidenced by weight loss