HYPERPARATHYROIDI

SM
Sukma Randani Ismono

HYPERPARATHYROIDISM

excessive release of PTH and manifests as

hypercalcemia
The parathyroid glands regulate serum
calcium and phosphorus levels through the
secretion of parathyroid hormone (PTH),
which raises serum calcium levels while
lowering the serum phosphorus concentration

1 in 500 women and 1 in 2000 men per year

Fifth, sixth, and seventh decades of life
Etiology
- Parathyroid adenoma
- Diffuse hyperplasia of all parathyroid glands
- External radiation to the head, neck, and
chest regions

Chronic renal failure

Malabsorption syndromes

CNS

Cardiovascular system

Osteoporosis
Easily fatigued muscle

GI system

Signs of hypertension and congestive heart failure may be

apparent, although little definitive evidence supports a
causal relationship.

Musculoskeletal system

Neuropsychiatric illness
Altered mental status
Coma (severe cases)

Pancreatitis, pancreatic calcification

Peptic ulcer disease

Renal system: recurrent calcium nephrolithiasis,

nephrocalcinosis, and impaired renal function.5

Dx

Elevated parathyroid hormone (PTH) levels

in the setting of hypercalcemia establish the
diagnosis of hyperparathyroidism.
The normal range for the PTH-intact assay is
generally 10-65 pg/mL.
A decreased serum phosphate level of less
than 2.5 mg/dL (0.81 mmol/L) may be seen.
Urinary calcium excretion may be elevated.
Radiography has limited diagnostic value

hydration is the principal primary therapy directed at

hypercalcemia.
the goal of treatment is to reduce the calcium level to below 11.5
mg/dL
Severe hypercalcemia is nearly always accompanied by severe
dehydration
normal saline.
loop diuretics facilitate
Caution :fluid and electrolyte disturbances
estrogen therapy has been advocated because it may inhibit
demineralization of the skeleton and may reduce blood calcium
levels
Surgery that involves open surgical excision with frozen section
diagnosis is the only definitive treatment for severe
hyperparathyroidism.
invasive parathyroidectomy
Cinacalcet (Sensipar)
Directly lowers PTH levels by increasing sensitivity of calciumsensing receptor on chief cell of parathyroid gland to extracellular
calcium. Also results in concomitant serum calcium level
decrease.

HYPOPARATHYROIDISM

condition in which the body produces too little

parathyroid hormone.
Blood calcium levels fall, and phosphorus levels rise
Etiology :
-Injury to the parathyroid glands during head and
neck surgery
-a side effect of radioactive iodine treatment
-low blood levels of magnesium, or when blood pH is
too high, a condition called metabolic alkalosis

Both hypermagnesemia and

hypomagnesemia can result in decreased
PTH secretion. In the case of
hypermagnesemia, elevated magnesium
levels result in stimulation of a calciumsensing receptor on the pituitary. This, in turn,
attenuates PTH secretion. In the case of
chronic alcoholics with hypomagnesemia,
there is diminution of PTH secretion levels
and a resistance to hormone activity

Tingling lips, fingers, and toes

Muscle cramps
Pain in the face, legs, and feet
Abdominal pain
Dry hair
Brittle nails
Dry, scaly skin
Cataracts
Weakened tooth enamel (in children)
Muscle spasms called tetany (can lead to spasms of the larynx,
causing breathing difficulties)
Convulsions (seizures)
Additional symptoms that may be associated with this disease
include:
Painful menstruation
Hand or foot spasms
Decreased consciousness
Delayed or absent tooth formation

severe hypocalcemia can result in

neuropsychiatric and cardiovascular
abnormalities. Neuropsychiatric
manifestations include irritability, anxiety,
psychosis, dementia, hallucinations,
depression, and confusion. The
cardiovascular effects of hypocalcemia are
usually bradydysrhythmias or prolongation of
the QT interval. Severe hypocalcemia can
rarely mimic myocardial infarction

DX

Low serum calcium level

High serum phosphorus level
Low serum parathyroid hormone level
Low serum magnesium level (possible)
Abnormal heart rhythms on ECG (possible)
This disease may also alter the results of the
following tests:
Urine calcium

MANAGEMENT

Oral calcium carbonate and vitamin D

supplements are usually lifelong therapy
High calsium diit
IV 10-30 mL of 10% calcium gluconate