Download Endocrine Disorders Parathyroid Gland

Endocrine Disorders
Parathyroid Gland
Jane E. Binetti DNP MSN RN
Parathyroid Glands
• 4 small glands embedded
into the posterior thyroid
• Very vascular
• Secretes PTH by feedback
▫ Regulates Calcium
 Bone reabsorption but inhibits formation
▫ Renal reabsorption of Calcium
▫ Renal conversion of Vit D to active form
Hyperparathyroidism
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Over secretion of PTH yields hi Ca++ levels
1% of population in the US
More women than men
30-70 – peaks at 40-50
Three classifications:
▫ Primary
▫ Secondary
▫ Tertiary
Primary Hyperparathyroidism
• Over secretion of PTH
▫ Causes disorders of calcium, phosphate and bones
• Causes:
▫ Benign tumor - adenoma
▫ H/o head and neck radiation
▫ Long term lithium treatment
Secondary Hyperparathyroidism
• Compensatory response to anything that causes
hypocalcemia
▫ Low Ca++ is the main stimulus for PTH
• Associated with:
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Vit D deficiency
Malabsorption
CKD
Hyperphosphatemia
Tertiary Hyperparathyroidism
• Caused by hyperplasia of the gland
• Negative feedback is lost
• Autonomous secretion
▫ Secretion of PTH even with normal levels of Ca
▫ Hypercalcemia will cause hypophosphatemia
▫ Seen in kidney transplant patients who have had
long term dialysis
What do you see?
• Some pts are asymptomatic, if symptomatic
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Muscle weakness
Loss of appetite, constipation
Emotional disorders, altered attention span
Osteoporosis, Nephrolithiasis
Serious effects: renal failure, pancreatitis, cardiac
arrhythmia, and fractures
Diagnostics
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PTH levels are elevated
Calcium levels are over 10mg/dL
Phosphorus is less than 3 mg/dL
DEXA scans
MRI, CT for tumor screening
Treatment depends on severity
Collaborative Care
• Surgery
▫ Used for primary and secondary disease
 Hypercalcemia, hypercalciuria, decreased bone density
▫ Partial or complete removal of glands
▫ Surgical or endoscopic
• Autotransplantation
▫ For inadvertent damage
▫ For continued calcium
▫ If it fails, continuous calcium supplements
Collaborative Care
• Non Surgical therapy for asymptomatic pts
▫ Meds do not treat underlying cause
 Bisphosphonates– inhibits osteoclast reabsorption
 Fosamax (alendronate) p.o; Aredia (pamindronate) IV
 Oral phosphate for pts with normal kidney fx, and low
PO4
 Diuretics
▫ Calcimimetics
 Sensipar (cinacalcet) sensitivity of Ca receptor of
gland
 Used for primary, or secondary with CRF
What do you do?
• Post op:
▫ Assess your patient!
▫ Watch for hemorrhage, F and E imbalance
▫ Risk of tetany from sudden drop in calcium
 Tingling, spasms, laryngospasms
 Keep calcium gluconate available
 Assess Chvostek’s and Trousseau’s sign
▫ Watch I and Os
▫ Dietary teaching
▫ Encourage mobility to promote bone strength
Hypoparathyroidism
• Uncommon condition, usually lack of PTH
• Results in hypocalcemia
• Causes:
▫ Most commonly iatrogenic
 Inadvertent removal with thyroid gland
 Damage to vascular supply
▫ Genetic
 Pseudohypoparathyroidism – PTH ok
▫ Idiopathic
 Rare, childhood, anti-parathyroid antibodies?
▫ Others
 Chronic low magnesium, heavy metal poisoning, tumors
What do we do?
• Treat acute complications
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Tetany
Administer IV Ca++ Carefully!!!
Hi Ca can cause cardiac dysrhythmias and phlebitis
Extravasation can cause necrosis
• Monitor:
▫ Cardiac function, muscle cramping, rebreathing
• Teach long term drug therapy
▫ Ca supplements
▫ Vitamin D (rocalcitrol)