1. Endocrine Disorders Parathyroid Gland
Jane E. Binetti DNP MSN RN

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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)