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 Autotransplantation 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 Monitor: 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)