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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 • • • • • 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: ▫ ▫ ▫ ▫ 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 ▫ ▫ ▫ ▫ ▫ Muscle weakness Loss of appetite, constipation Emotional disorders, altered attention span Osteoporosis, Nephrolithiasis Serious effects: renal failure, pancreatitis, cardiac arrhythmia, and fractures Diagnostics • • • • • • 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 ▫ ▫ ▫ ▫ 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)